The use of an algorithm and tailored counselling improves the frequency of growth monitoring and promotion sessions and proportion of mothers receiving counselling in a rural district

Abstract

The lack of counselling tools and aids and the poor health personnel knowledge of infant and young child feeding practices in Ghanaian growth monitoring and promotion (GMP) services impede efforts to address mild (-2 ≤ weight-for-length z score (WLZ) < -1) to moderate (-3 ≤ WLZ < -2) wasting. A cluster-randomized intervention was used to compare three treatments targeted at children less than 24 months: (i) control group, use of the standard-of-care (SOC) weight measurements, weight-for-age z-score (WAZ) chart, and the Ghana Health Service counselling cards; (ii) algorithm group, use of a newly-developed algorithm and SOC; and (iii) length group, measurement of length, use of WLZ chart, and SOC. Thirty clusters of rural communitybased GMP clinics were randomly assigned to the three treatment groups (n = 10 per group). Using crosssectional surveys at baseline (n = 661) and one year later (n = 666), we tested differences in prevalence of low WLZ (WLZ < -1) in children from 0 to 24 months. Analyses were by intention-to-treat, adjusting for clustering effect. There was no significant effect of the intervention on low WLZ (p = 0.66). However, the quality of GMP implementation differed among the treatments. The algorithm and length groups had a significantly higher (mean difference: 2.7 [95% CI: 0.01 - 5.40] and 2.93 [95% CI: 0.55 – 5.31], respectively) number of GMP sessions held compared to the control. Compared to the length group, the algorithm and control groups had higher (mean difference: 0.24 [95% CI: 0.17 – 0.31] and 0.23 [95% CI: 0.15 – 0.31], respectively) proportions of mothers receiving individual counselling at sessions. Having a simple focused tool may improve the frequency of GMP sessions and quality of nutrition counselling provided. There is a need for an evaluation of rural GMP programs to identify bottlenecks and how these can be addressed for higher program impact.