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Impact of Growth Monitoring Education on Growth Monitoring Practices among Mothers of Under-Five Children in Nigeria

Abstract

Growth monitoring is an important component of child health because regular assessment of a child's growth can help parents and healthcare providers identify growth faltering, undernutrition, and other health problems at an early stage. Mothers and other primary caregivers play a central role in ensuring that children attend routine growth monitoring services and that appropriate actions are taken when abnormal growth patterns are identified. Growth monitoring education provides mothers with knowledge and practical information regarding the importance of monitoring children's growth, recommended growth monitoring schedules, interpretation of growth charts, recognition of growth faltering, appropriate nutrition and feeding practices, immunization and preventive healthcare, and the importance of seeking professional care when concerns about a child's growth arise. Growth monitoring practices refer to mothers' actions relating to regular attendance at child growth monitoring services, keeping and presenting child health records, monitoring weight and other growth indicators, understanding growth trends, responding appropriately to abnormal growth patterns, and seeking healthcare when growth concerns are identified. In Nigeria, inadequate knowledge of growth monitoring, limited awareness of recommended schedules, misconceptions regarding child growth, long distances to healthcare facilities, transportation costs, competing household responsibilities, and inconsistent access to child health services may affect mothers' growth monitoring practices. Effective growth monitoring education may improve mothers' knowledge, awareness, confidence, and participation in routine growth monitoring services. Against this background, this study investigates the impact of growth monitoring education on growth monitoring practices among mothers of under-five children in Nigeria. The study is anchored on Social Cognitive Theory, the Health Belief Model, and the Theory of Planned Behaviour. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, behavioural capabilities, social influences, and environmental conditions in shaping mothers' child-health behaviours. 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 participate in child growth monitoring. The Theory of Planned Behaviour explains how attitudes, subjective norms, perceived behavioural control, and behavioural intentions influence mothers' decisions to engage in recommended child health practices. Collectively, these theoretical perspectives provide a suitable framework for explaining how growth monitoring 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 of under-five children attending selected public and private healthcare facilities and community-based child health services in Nigeria using a structured interviewer-administered questionnaire, growth monitoring knowledge assessment, and growth monitoring practices assessment tool. A multistage sampling technique will be employed to select states, local government areas, healthcare facilities or communities, and eligible mothers. Where feasible, selected mothers or groups will be assigned to intervention and comparison groups. Mothers in the intervention group will receive structured growth monitoring education covering the importance of routine growth monitoring, recommended attendance schedules, interpretation of child growth charts, recognition of growth faltering, appropriate nutrition and feeding practices, the importance of immunization and preventive healthcare, maintenance of child health records, and appropriate action when abnormal growth is identified. Growth monitoring practices will be assessed using indicators such as regular attendance at growth monitoring sessions, completion of scheduled monitoring visits, keeping and presenting child health records, monitoring of child growth measurements, interpretation of growth trends, recognition of abnormal growth patterns, and timely healthcare-seeking when growth concerns arise. Where feasible, child health records will be reviewed to complement self-reported information and improve measurement accuracy. Descriptive statistics will be used to summarize mothers' sociodemographic characteristics, child characteristics, growth monitoring knowledge, exposure to education, and growth monitoring practices. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and logistic or multiple regression analysis, will be used to determine the impact of growth monitoring education on growth monitoring practices. Where appropriate, pre-intervention and post-intervention practice measures will be compared. Diagnostic tests will also be conducted to assess the reliability of the research instruments, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that growth monitoring education has a significant positive impact on growth monitoring practices among mothers of under-five children in Nigeria. Mothers exposed to structured growth monitoring education are expected to demonstrate improved knowledge and greater participation in recommended growth monitoring activities. Education may improve regular attendance at growth monitoring sessions, understanding of growth charts, maintenance of child health records, recognition of growth faltering, and timely healthcare-seeking when abnormal growth is identified. It may also improve mothers' understanding of the relationship between growth monitoring, appropriate child nutrition, preventive healthcare, and early detection of childhood health problems. However, education alone may not guarantee sustained growth monitoring practices because mothers may continue to face barriers such as transportation costs, distance to healthcare facilities, long waiting times, competing household responsibilities, limited availability of growth monitoring services, and inadequate continuity of child health services. Consequently, growth monitoring education is expected to be most effective when supported by accessible child health services, reliable growth-monitoring equipment, trained healthcare workers, community outreach programmes, appropriate referral systems, and continuous maternal and child health education. The study is expected to contribute to the literature on child growth monitoring, maternal and child health, child nutrition, health education, child survival, preventive healthcare, and public health in Nigeria by providing empirical evidence on the impact of growth monitoring 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, state ministries of health, primary healthcare facilities, hospitals, maternal and child health programmes, nutrition programmes, community health workers, development partners, and policymakers regarding strategies for improving child growth monitoring. The study will also provide evidence-based recommendations for strengthening maternal education, integrating growth monitoring education into routine child welfare services, improving community-based growth monitoring, ensuring availability of functional growth-monitoring equipment, strengthening healthcare worker counselling, and promoting regular growth monitoring among mothers of under-five children in Nigeria.

Keywords: Growth monitoring education, growth monitoring practices, mothers, under-five children, child growth, child nutrition, maternal and child health, growth monitoring, child welfare, health education, preventive healthcare, child health, public health, Nigeria.