Growth Monitoring and Promotion in Rural Ghana: Lack of Motivation or Tools?

The effectiveness of growth monitoring and promotion (GMP) activities depend on the motivation and performance of nutrition educators. A 12‐mo capacity‐building intervention was carried out to improve identification and mitigation of child wasting. 30 community‐based GMP clinics in Upper Manya Krobo District, Ghana were randomized into: algorithm (A), length measurement (L), or control (C) groups. In A group, a simple algorithm based on predictors of wasting, helped community health workers (CHW) identify at‐risk children and provide tailored counseling. Length in addition to usual weight measurements allowed L group CHW to identify children with low weight‐for‐length. Standard‐of‐care was used in C group. Type of nutrition counseling given and caregivers' recall of nutrition messages were documented through direct observations of CHW and interviews with caregivers at monthly GMP sessions. About 30% of scheduled sessions were missed because of poor road conditions, disabled transportation, and scheduling conflicts. Out of the sessions held, only 60% provided individual counseling (IC). IC was not offered because of nurses' exhaustion, inadequate time due to late arrival of nurses and/or mothers, and caregivers' time complaints. 80% of observed caregivers recalled IC messages after one week; this did not differ by treatment. The proportion of GMP sessions and IC held was higher in A vs. C group (0.83 vs. 0.54 and 0.55 vs. 0.36, respectively; p< 0.01). GMP programs need mechanisms to motivate CHW to improve their effectiveness and mothers to improve their involvement in GMP. Having a clear, simple educational tool may provide needed support to improve GMP in Ghana. [Funded by IDRC and DFATD, Canada]