This health institution based cross- sectional study design was employed to assess child growth monitoring and promotion (GMP) practice and associated factors among health care workers who provided GMP service at public health institutions in South Wollo Zone, Amhara Region, Ethiopia.
The finding showed that the overall proportion of good child GMP practice was 58.4% with (95% CI: 54.0–63.0). The finding of this study revealed that the proportion of good child GMP practice was slightly higher than reports from North Gonder Zone, Amhara Region (50.4%) (17) and Tigray region, Ethiopia (53.6%) (14). The possible reason for this variation might be the difference in the study setting. This may also be attributed to the time difference as there could be current improvement in accessing and practicing GMP service through time and other factors could be attributed to place variation between this and previous studies.
In view of addressing the second objective, an attempt was made to examine the associations between dependent variables and the independent variable. Multivariable logistic regression analysis was used to identify factors associated with GMP practice of health care workers. The model identified educational level of health care workers, work experience on GMP practice, training on GMP practice, availability of GMP equipment and attitude of health care workers towards GMP having statistical significant association with GMP practice of health care workers.
Regarding educational level of health care workers, first degree health care workers have positive association with GMP practice. This study revealed that the odds of GMP practice among first degree health care workers were two times higher as compared to the odds of GMP practice among certificate health care workers. Study from North Gondar Zone, Amhara Region, Ethiopia stated that first degree health care workers had no significant association with GMP practice (17). The absence of association seen between first degree health care workers and GMP practice in the previous study might be due to the participant’s background. Degree holder health care workers participant in the previous study might be direct university graduate who might not receiving in-service-training on GMP practice during the time when the researcher conducted the study.
Similarly, diploma health care workers have positive association with GMP practice. This study revealed that the odds of GMP practice among diploma health care workers were almost four times higher as compared to the odds of GMP practice among certificate health care workers. Study from North Gondar Zone, Amhara Region, Ethiopia reported that diploma health care workers has positive association with GMP practice (17). The possible explanation for the difference between first degree and diploma health care workers with certificate health care workers in terms of GMP practice might be their educational background. It is to mean, that being first degree and diploma holder health care workers might offer a first-hand chance to the professionals to have exposure for any training, including GMP practice and experience sharing conference which made them more aware about GMP service than those who had certificate to utilized available GMP equipment and GMP service.
The other factors that were positively associated with GMP practice of health care workers in this study were length of work experience. The odds of GMP practice among health care workers who had work experience ≥ 11 years were three times higher as compared to the odds of GMP practice among health care workers who had work experience 1–10 years. This result is in line with the study conducted in North Gonder Zone, Amhara region, Ethiopia (17). The possible explanation might be that long time they spent in GMP service practice might be account to their present performance. When experience is increased learning becomes more constructed as a result performance on GMP practice would become better.
In the present study availability of GMP equipment in the health institution was positively associated with health care workers GMP practice. The odds of GMP practice of the health care workers who have availability of GMP equipment in the health institution were almost three times higher as compared to the odds of GMP practice of the health care workers who did not have GMP equipment. This is similar with a study done in North Gonder Zone, Amhara Region, Ethiopia (17). The possible explanation might be that the existence of adequate equipment provides more chance of exposure to the health care workers to practice GMP than those who had no equipment in their health institution. This result was also supported by the result obtained from interview.
“…There is lack of GMP equipment and shelter to perform GMP. When we have everything at hand then everything works on GMP well." (A 30 years old rural health extension workers)
A positive association between health care workers with positive attitude and their GMP practice was also observed in this study. The odds of GMP practice among health care workers who had positive attitude towards GMP were four times higher as compared to the odds of GMP practice among health care workers who had negative attitude towards GMP. This was agreed with the finding gathered from interview.
“…GMP is a good and important tool, easy to use and effective. It is one of the services that we have to do to reduce child under nutrition. (A 32 years old urban health extension worker)
However, this finding is not in agreement the study carried out in North Gonder Zone, Amhara Region, Ethiopia which shown that a negative association between positive attitude of health care workers and their GMP practice (17). The possible justification for the result gained in this study might be the existing situation in the place where the health care workers have worked. It is to say that the factors like work load and job dissatisfaction less likely affect the health care workers attitude which in turn enables them to performance GMP practice as seen in the present study result.
Conversely, in this study a positive association was found between attending training on GMP and GMP practice of health care workers. The odds of GMP practice of the health care workers who have got training on GMP were five times higher as compared to the odds of GMP practice of the health care workers who did not get training on GMP. This result was also supported by the result obtained from interview.
“…. Even if we have been trained, the training is not adequate. In-service training on growth monitoring and promotions service is important, if there are changes every time there is a different way of doing things, to keep up the standard and to update the procedures of GMP, training is important.” (A 29 years old rural health extension worker) .However, this result is in contrast with the study conducted in North Gonder Zone, Amhara Region, Ethiopia which showed that attending training on GMP has no significant association with GMP practice (17). The possible explanation for this varying result in this study might be the mode of delivery of GMP training might be appropriate, the topic of the training might be relating to GMP service, the training might be delivered by GMP experts all which made the health care workers perform GMP in better way.
The practical implication of this finding is that GMP practice clearly related to health care workers’ educational level, work experience, training, positive attitude towards GMP and availability of GMP equipment. Health care workers who have first degree and diploma, higher work experience on GMP, training on GMP, positive attitude towards GMP are more likely to practice GMP. It will use as an input for national nutritional strategy, national nutritional program of Ethiopia and Thin on the Ground (Save the Children UK in Ethiopia) goal which were targeted to reduce malnutrition. In addition to this, it is an input for declarations that programmed to end up malnutrition problems which were planned by the government of Ethiopia such as Seqota declarations.
The strength of this study is that it is being quantitative method triangulated with qualitative method to supplement the results and also to explore factors that are not addressed by quantitative method. Limitation of the study should be noted and taken into consideration. Cross-sectional nature of this study did not reveal causal links between independent variables and child growth monitoring and promotion practice.