The efficacy and related factors of the growth monitoring and promotion programme in clinics of Vhembe district, South Africa.

Doctoral Degree. University of KwaZulu-Natal, Pietermaritzburg.

Aim: To determine the growth monitoring and promotion (GMP) related knowledge, perceptions and skills of nursing staff and mothers with IYC under five at selected clinics in the rural areas of Vhembe district, Limpopo Province, South Africa. Methods: The study sample included 82 randomly selected clinics from the four subdistricts in Vhembe district, Limpopo province. In three of the four sub-districts, 24 clinics were sampled from from each, while the fourth sub-district was represented by ten clinics. A cross-sectional exploratory descriptive survey employing quantitative and qualitative data collection techniques was conducted to explore the variables under investigation. The quantitative phase included 312 nursing staff with an equal number of participants from each randomly sampled clinic. Data collection was conducted by trained fieldworkers using a research instrument consisting of open- and closed-ended questions, as well as an observation tool. A recording sheet was used for documenting the prevalence of moderate- and severe acute malnutrition in the district. For the qualitative phase, nine focus group discussions (FGDs), with a total of 83 purposively sampled biological mothers of IYC were conducted in three of the four sub-districts using a semi-structured interview guide. Means and standard deviations were computed for continuous variables. A comparison between means was conducted using the independent samples t-test, while correlations between continuous variables were done with Pearson’s correlations. Frequency distributions were calculated for categorical variables, followed by Chi-square tests to determine the relationship between categorical variables. Time series analysis by means of ANOVA was used to analyse the prevalence of SAM/MAM across the five years for which clinic statistics were obtained. For the qualitative phase of the study, FGDs were recorded on a digital voice recorder with verbatim transcripts being translated into English by back translation. These transcripts were imported into Atlas ti. version 8.4 computer software for thematic content analysis, followed by the creation of themes and sub-themes for creating codes and networks of responses. Results: Participating nursing staff that worked with GMP for 12.0 ± 8.8 years, had a mean knowledge score regarding GMP of 48.9%, with 40% having a score of ≤ 50%. Fieldworker observations of nursing staff while conducting growth monitoring (GM), generated evidence that the majority of participants did not follow the correct procedure when measuring weight, length, height or mid-upper arm circumference (MUAC). The low mean scores obtained for knowledge, as well as the ability to interpret growth indicators, are cause for concern. In addition, 20.1% of the study sample was never offered training and/or never attended refresher training following completion of their formal training. A significant positive correlation was documented for knowledge regarding GMP and the ability of participants to interpret growth indicators if both mean values were expressed as percentages (r=0.251; p<0.000). Based on the FGD discussions conducted with mothers, it was evident that they knew the importance of taking their IYC to the clinic for GMP, despite the fact that some were not familiar with the reasons for its importance. Conclusion: Although nursing staff had positive perceptions regarding GMP, their knowledge regarding the programme, as well as their ability to accurately conduct anthropometric measurements was not optimal. Mothers of IYC that make use of GMP in Vhembe district have the necessary knowledge regarding its importance. However, there are several barriers preventing them from optimally utilising the GMP services offered by clinics. Findings highlight the need for nursing staff, clinics and the Department of Health to address the barriers mothers face, as it has the potential to impact on the aims and successful implementation of GMP in the district. Key concepts: Clinics, GMP, knowledge, mothers with IYC, nursing staff and skills.