Socio- economic characteristics of study participants
A total of 358 mothers (89 cases and 269 controls) with 98.6% response rate were included in the study. The mean age of mothers was 27.28 with SD of ±5.074. The average family size was 4.4 with SD of ±1.50. About 55(61.8%) and 150(55.8%) of respondents were farmers among case and controls, respectively (Table 1).
Table 1: Socio-economic characteristics of mothers/caregivers in Legambo district, South Wollo zone, Northern Ethiopia, 2020.
Variable
|
Case: n= 89 (%)
|
Control: n = 267 (%)
|
|
Maternal age
|
|
|
|
|
15-19
|
3
|
3
|
|
20-24
|
23(25.8)
|
86(32)
|
|
25-29
|
32(36)
|
91(33.8)
|
|
30-34
|
23(25.8)
|
65(24.2)
|
|
35-39
|
7(7.9)
|
21(7.8)
|
|
>40
|
|
|
Marital status
|
|
|
|
Married
|
89
|
263(97.8)
|
|
Divorced
|
0
|
3
|
|
Widowed
|
0
|
3
|
|
Maternal education
|
|
|
|
Cannot read and write
|
26(29.2)
|
132(49.1)
|
|
Can read and write
|
2
|
5(1.9)
|
|
Primary school
|
31(34.8)
|
94(34.9)
|
|
Secondary and above
|
30(33.7)
|
38(14.1)
|
|
Husband education
|
|
|
|
Cannot read and write
|
25(28.1)
|
133(49.4)
|
|
Can read and write
|
5(5.6)
|
22(8.2)
|
|
Primary
|
26(29.2)
|
75(27.9)
|
|
Secondary and above
|
33(37.1)
|
39(14.5)
|
|
Occupation of mother
|
|
|
|
House wife
|
22(24.7)
|
99(36.8)
|
|
Farmer
|
45(50.6)
|
150(55.8)
|
|
Merchant
|
11(12.4)
|
12(4.5)
|
|
Government employee
|
10(11.2)
|
3
|
|
Private employee
|
1
|
5(1.9)
|
|
Husband occupation
|
|
|
|
Farmer
|
55(61.8)
|
216(80.3)
|
|
Merchant
|
8(9)
|
28(10.4)
|
|
Government employee
|
21(23.6)
|
7(2.6)
|
|
Private employee
|
5(5.6)
|
10(3.7)
|
|
Daily laborer
|
0
|
7(2.6)
|
|
Student
|
0
|
1
|
|
Wealth index
|
|
|
|
High
|
37(41.6)
|
84(31.2)
|
|
Medium
|
27(30.3)
|
95(35.3)
|
|
Low
|
25(28.1)
|
90(33.5)
|
|
Family size
|
|
|
|
<4
|
60(67.4)
|
162(60.2)
|
|
4-5
|
13(14.6)
|
38(14.1)
|
|
> 5
|
16(18)
|
69(25.7)
|
|
Birth order
|
|
|
|
1
|
37(41.6)
|
94(34.9)
|
|
2-3
|
36(40.4)
|
106(39.4)
|
|
>3
|
16(18)
|
69(25.7)
|
|
Growth Monitoring and Promotion service and child age
High utilization of GMP observed in both cases and controls in the age group of 12-17 months age, 35(39.3%) and 74 (27.5%), respectively. While low utilization of GMP service utilization was reported among cases 7(7.9%) within the age group of 0-5 months of age (Figure 1).
Figure 1:- Growth Monitoring and Promotion service and child age in Legambo district, South Wollo zone, Northern Ethiopia, 2020.
Maternal knowledge and attitude to GMP service
Around 72(80.9%) of cases and 133(49.4%) of controls group had good knowledge. Regarding the attitude; (83.1% of cases and 48% of controls) had favorable attitude. About 16 (18%) of cases and 32% of controls don't know when the growth monitoring service is started (Table 2).
Table 2: knowledge and attitude of mothers/caregivers towards GMP service utilization in Legambo district, South Wollo zone, Northern Ethiopia, 2020.
Variable
|
Case: n = 89 (%)
|
Control: n = 267 (%)
|
Heard about GMP
|
|
|
Yes
|
87(97.8)
|
194(72.1)
|
No
|
2
|
75(20.9)
|
Know the age groups for GMP
|
|
|
Yes
|
77(86.5)
|
193(75.4)
|
No
|
12(3.4)
|
76(21.2)
|
Know the starting time for GMP
|
|
|
Yes
|
73(82)
|
183(68)
|
No
|
16(18)
|
86(32)
|
Know interval between GMP
|
|
|
Yes
|
82(92.1)
|
175(65.1)
|
No
|
7(7.9)
|
94(34.9)
|
Know who to perform GMP
|
|
|
Yes
|
84(94.4)
|
182(67.7)
|
No
|
5(5.6)
|
87(32.3)
|
Know place of GMP services
|
|
|
Yes
|
85(95.5)
|
191(71)
|
No
|
4(4.5)
|
78(29)
|
GMP service has benefit for the child
|
|
|
Yes
|
88(98.9)
|
222(82.5)
|
No
|
1
|
47(17.5)
|
Know when the growth chart is flattening
|
|
|
Yes
|
70(78.7)
|
135(50.2)
|
No
|
19(21.3)
|
134(49.8)
|
Know when the growth chart is rising
|
|
|
Yes
|
70(78.7)
|
134(49.8)
|
No
|
19(21.3)
|
135(50.2)
|
Know when the growth chart is falling
|
|
|
Yes
|
70(78.7)
|
133(49.4)
|
No
|
19(21.3)
|
136(50.6)
|
Knowledge
|
|
|
Good
|
72(80.9)
|
133(49.4)
|
Poor
|
17(19.1)
|
136(30.6)
|
Attitude
|
|
|
Favorable
|
74(83.1)
|
129(48)
|
Unfavorable
|
15(16.9)
|
140(52)
|
Health care service related characteristics
About 74(83.1%) mothers in cases group (utilized) and 132(49.1%) mothers/caregivers in the controls group (Non- utilized) had 4 and above antenatal care (ANC) visits. Majority of mothers/caregivers in both cases group (67.4%) and controls group (71%) gave birth (for this baby) in health institutions. Only 70(78.7%) mothers in case groups and 123(45.7%) mothers in control group were counseled on GMP (Table-3).
Table 3- Health care service utilization related characteristics of mothers/caregivers in Legambo district, South Wollo zone, Northern Ethiopia, 2020.
Variable
|
Case: n = 89 (%)
|
Control: n = 267 (%)
|
|
|
|
Place of delivery
|
|
|
Home
|
29(32.6)
|
78(29)
|
Health institution
|
60(67.4)
|
191(71)
|
Immunization
|
|
|
Fully immunized
|
86(96.6)
|
262(97.4)
|
Not immunized
|
3(3.4)
|
7(2.6)
|
ANC utilization
|
|
|
Yes
|
74(83.1)
|
132(49.1)
|
No
|
15(16.9)
|
137(50.9)
|
PNC utilization
|
|
|
Yes
|
68(76.4)
|
117(43.5)
|
No
|
21(23.6)
|
152(56.5)
|
Counseling on GMP
|
|
|
Yes
|
70(78.7)
|
123(45.7)
|
No
|
19(21.3)
|
146(54.3)
|
Service quality
|
|
|
Good
|
51(57.3)
|
127(47.2)
|
Poor
|
38(42.7)
|
142(52.8)
|
Distance to health facility
|
|
|
< 1 hour
|
79(88.8)
|
154(57.2)
|
≥1 hour
|
10(11.2)
|
115(42.8)
|
Mode of delivery
|
|
|
SVD
|
85(95.5%)
|
257(95.5%)
|
instrumental
|
0
|
5(2.6)
|
C/section
|
4(1.9)
|
7(4.5)
|
Counseled on Nutrition
|
|
|
Yes
|
88(98.9)
|
32(11.9)
|
No
|
1
|
237(88.1)
|
Vitamin A supplementation
|
|
|
Yes
|
86(96.6)
|
45(16.7)
|
No
|
3
|
224(83.3)
|
Birth order
|
|
|
1
|
37(41.6)
|
94(34.9)
|
2-3
|
36(40.4)
|
106(39.4)
|
|
|
|
Determinants of GMP service utilization
In the Bivariable regression analysis, child age, paternal education, maternal education, antenatal care utilization, counseling on GMP service utilization, postnatal care utilization, knowledge, attitude, service quality, access to media and distance to health facility were associated with the GMP. Variables with a p-value < 0.25 were transferred to multivariable logistic regression. Child age, knowledge, attitude, counseling on GMP, ANC service utilization and distance to health facility were independent predictors of GMP service utilization at p-value<0.05.
Mothers/caregivers who had good knowledge were 2.4 times more likely utilize GMP service compared to mothers/caregivers who had poor Knowledge (AOR) = 2.42; 95% CI: 1.23, 4.75).
Mothers/caregivers who had received counseling on GMP service were 2.3 times more likely utilize GMP service compared to mothers/caregivers who had not received counseling (AOR = 2.34, 95% CI: 1.19, 4.56). Mothers/caregivers who reached near by the health facility less than one hour were 4.5 times more likely to utilize GMP service as compared to mothers/caregivers who reached greater than one hour (AOR = 4.53; 95% CI: 1.99, 10.28).
Mothers/caregivers who had utilized ANC services were 2.46 times more likely to utilize GMP services as compared to mothers/caregivers who had not utilized ANC services (AOR = 2.46; 95% CI: 1.18, 5.16). Mothers/caregivers/ who had favorable attitude were 2.45 times more likely to utilize GMP services as compared to unfavorable attitude(AOR = 2.45; 95% CI: 1.20, 4.98).
Mothers who have children age group between 12-17 months were 3 times and 18-23months age groups were 4 times more likely to utilize GMP services as compared to who have Children with 0-5 age groups(AOR = 3.45; 95% CI: 1.26, 9.41) and (AOR = 4.38; 95% CI: 1.53, 12.49), respectively (Table 4).
Table 4- Predictors of GMP services utilization among children 0–23 months of age in Legambo district, South Wollo zone, Northern Ethiopia, 2020.
Variable
|
Cases
|
Controls
|
95% confidence interval
|
COR
|
AOR
|
Mother educational level
|
|
|
|
|
Illiterate
|
26(29.2%)
|
132(49.1%)
|
1
|
1
|
read and write
|
2(2.2%)
|
5(1.9%)
|
2.03(0.37-11.04)
|
1.32(0.19-9.17)
|
Primary
|
31(34.8%)
|
94(34.9%)
|
1.67(0.93-3.00)
|
1.29(0.52-3.22)
|
Secondary and above
|
30(33.7%)
|
38(14.1%)
|
4.01(2.12-7.58)
|
1.96(0.68-5.69)
|
Partner education
|
|
|
|
|
Illiterate
|
25(28.1%)
|
133(49.4%)
|
1
|
1
|
read and write
|
5(5.6%)
|
22(8.2%)
|
1.21(0.42-3.49)
|
0.89(0.23-3.50)
|
Primary
|
26(29.2%)
|
75(27.9%)
|
1.84(0.99-3.42)
|
1.25(0.49-3.19)
|
Secondary and above
|
33(37.1%)
|
39(14.5%)
|
4.5(2.39-8.46)
|
1.87(0.68-5.13)
|
Child age in months
|
|
|
|
|
0-5
|
7(7.9%)
|
67(24.9%)
|
1
|
1
|
6-11
|
17(19.1%)
|
67(24.9%)
|
2.43(0.95-6.24)
|
2.67-(0.91-7.85)
|
12-17
|
35(39.3%)
|
74(27.5%)
|
4.53(1.89-10.87)
|
3.45(1.26-9.41)*
|
18-23
|
30(33.7%)
|
61(22.7%)
|
4.70(1.93-11.49)
|
4.38(1.53-12.49)**
|
Maternal knowledge
|
|
|
|
|
Good
|
72(80.9%)
|
133(49.4%)
|
4.33(2.42-7.73)
|
2.42(1.23-4.75)*
|
Poor
|
17(19.1%)
|
136(30.6%)
|
1
|
1
|
Maternal attitude
|
|
|
|
|
Favorable
|
74(83.1%)
|
129(48.0%)
|
5.35(2.92-9.79)
|
2.45(1.20-4.98)*
|
Unfavorable
|
15(16.9%)
|
140(52.0%)
|
1
|
1
|
Counseling on GMP
|
|
|
|
|
Yes
|
70(78.7%)
|
123(45.7%)
|
4.37(2.49-7.66)
|
2.34(1.19-4.56)*
|
No
|
19(21.3%)
|
146(54.3%)
|
1
|
1
|
Access to media
|
|
|
|
|
Yes
|
52(58.4%)
|
114(42.4%)
|
1.91(1.18-3.11)
|
0.92(0.48-1.77)
|
No
|
37(41.6)
|
155(57.6%)
|
|
|
Distance to health facility
|
|
|
|
|
< 1 hour
|
79(88.8%)
|
154(57.2%)
|
5.89(2.93-11.89)
|
4.53(1.99-10.28)**
|
>1 hour
|
10(11.2%)
|
115(42.8%)
|
1
|
1
|
Service quality
|
|
|
|
|
Good
|
51(57.3%)
|
127(47.2%)
|
1.50(0.93-2.43)
|
1.12(0.60-2.07)
|
Poor
|
38(42.7%)
|
142(52.8%)
|
1
|
1
|
ANC service utilization
|
|
|
|
|
Yes
|
74(83.1%)
|
132(49.1%)
|
5.12(2.79-9.37)
|
2.46(1.18-5.16)*
|
No
|
15(16.9%)
|
137(50.9%)
|
1
|
1
|
PNC service utilization
|
|
|
|
|
Yes
|
68(76.4%)
|
117(43.5%)
|
4.20(2.44-7.26)
|
1.89(0.95-3.62)
|
No
|
21(23.6%)
|
152(56.5%)
|
1
|
1
|
*P-value <0.05; ** P-value <0.001