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Influence of Childhood Malnutrition Education on Growth Monitoring Practices among Mothers of Under-Five Children in Nigeria

Abstract

Childhood malnutrition remains an important public health concern in Nigeria and includes undernutrition, stunting, wasting, underweight, and micronutrient deficiencies, which can adversely affect children's growth, development, immunity, educational attainment, and long-term health. Early identification of growth problems is essential for preventing severe malnutrition and improving child health outcomes. Growth monitoring is an important child-health practice that involves the regular assessment and interpretation of a child's growth, including monitoring weight, length or height, and other appropriate growth indicators over time. Childhood malnutrition education provides mothers with information about the causes, risk factors, signs, consequences, prevention, and management of childhood malnutrition, as well as the importance of appropriate infant and young child feeding, regular growth monitoring, and timely utilization of healthcare services when growth abnormalities are identified. Growth monitoring practices refer to mothers' regular utilization of appropriate growth monitoring services, participation in scheduled child-health visits, understanding of growth measurements, recognition of abnormal growth patterns, and appropriate follow-up when concerns are identified. In Nigeria, inadequate knowledge, limited awareness of growth monitoring services, misconceptions about child growth, poor access to healthcare facilities, financial constraints, and competing household responsibilities may affect mothers' utilization of growth monitoring services. Effective childhood malnutrition education may improve mothers' knowledge and encourage appropriate growth monitoring practices. Against this background, this study investigates the influence of childhood malnutrition education on growth monitoring practices among mothers of under-five children in Nigeria. The study is anchored on the Health Belief Model, Social Cognitive Theory, and Knowledge-Attitude-Practice framework. The Health Belief Model explains preventive health behaviour through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action, providing a basis for understanding mothers' decisions to utilize growth monitoring services. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, social influences, behavioural capabilities, and environmental conditions in shaping maternal and child-health practices. The Knowledge-Attitude-Practice framework provides a basis for examining how improved knowledge and attitudes resulting from malnutrition education may influence growth monitoring practices. Collectively, these theoretical perspectives provide a suitable framework for explaining how childhood malnutrition education may influence growth monitoring practices among mothers of under-five children in Nigeria. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from mothers or primary caregivers of under-five children in selected communities and healthcare facilities in Nigeria using a structured interviewer-administered questionnaire and, where feasible, a growth monitoring record review. A multistage sampling technique will be employed to select states, local government areas, communities, healthcare facilities, households, and eligible mothers. Where feasible, selected participant groups or communities will be assigned to intervention and comparison groups. Mothers in the intervention group will receive structured childhood malnutrition education covering causes and types of malnutrition, risk factors, signs and consequences, appropriate infant and young child feeding, dietary diversity, prevention strategies, growth monitoring, interpretation of growth trends, recognition of growth faltering, and timely healthcare seeking. Growth monitoring practices will be assessed using indicators such as frequency of attendance at growth monitoring sessions, regularity of child growth assessments, use of child health cards, knowledge of growth measurements, recognition of abnormal growth patterns, and appropriate follow-up after identification of growth concerns. Where feasible, growth monitoring attendance and measurements will be verified using child health cards, growth charts, or healthcare facility records. Descriptive statistics will be used to summarize mothers' sociodemographic characteristics, malnutrition knowledge, exposure to education, and growth monitoring practices. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and multiple regression analysis, will be used to determine the influence of childhood malnutrition education on growth monitoring practices. Appropriate diagnostic tests will also be conducted to assess the reliability of the research instrument, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that childhood malnutrition education has a significant positive influence on growth monitoring practices among mothers of under-five children in Nigeria. Mothers exposed to structured malnutrition education are expected to demonstrate improved knowledge of childhood malnutrition and greater awareness of the importance of regular growth monitoring. Education may encourage mothers to attend growth monitoring sessions more regularly, use child health cards appropriately, understand growth measurements, recognize possible growth faltering, and seek professional assistance when abnormal growth patterns are identified. However, education alone may not guarantee consistent growth monitoring because mothers may continue to face barriers such as distance to healthcare facilities, transportation difficulties, financial constraints, long waiting times, competing household responsibilities, and inadequate availability of growth monitoring services. Consequently, childhood malnutrition education is expected to be most effective when supported by accessible child-health services, trained healthcare workers, functional growth monitoring systems, reliable growth-monitoring equipment, community mobilization, and appropriate referral and follow-up services. The study is expected to contribute to the literature on childhood malnutrition prevention, growth monitoring, maternal and child health, nutrition education, child survival, and public health in Nigeria by providing empirical evidence on the influence of childhood malnutrition education on growth monitoring practices among mothers of under-five children. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency (NPHCDA), state ministries of health, primary healthcare facilities, nutrition programmes, community health workers, child-health programmes, development partners, and policymakers regarding strategies for improving early detection and prevention of childhood malnutrition. The study will also provide evidence-based recommendations for strengthening maternal and community-based malnutrition education, improving growth monitoring services, integrating nutrition education into routine child-health programmes, strengthening growth chart utilization, improving referral systems, and promoting regular growth monitoring among mothers of under-five children across Nigeria.

Keywords: Childhood malnutrition education, growth monitoring practices, mothers, under-five children, malnutrition, child growth, nutrition education, maternal and child health, growth monitoring, child survival, health promotion, public health, Nigeria.