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

Abstract

Child growth monitoring is an important component of child health because regular assessment of growth can help identify growth faltering, undernutrition, overweight, and other health or nutritional concerns among children under five years of age. Mothers and other primary caregivers play an important role in ensuring that young children attend growth-monitoring services and that growth information is understood and appropriately acted upon. However, limited knowledge of growth-monitoring procedures, poor understanding of growth charts, inadequate awareness of recommended monitoring schedules, financial constraints, competing household responsibilities, misconceptions, and limited access to child-health services may affect mothers' participation in child growth monitoring. Growth-monitoring education provides an opportunity to improve mothers' understanding of the purpose of growth monitoring, interpretation of growth information, recommended follow-up, nutrition, and appropriate healthcare-seeking when abnormalities are identified. Against this background, this study investigates the impact of growth-monitoring education on child growth-monitoring practices among mothers of under-five children in Nigeria. The study will be anchored on the Health Belief Model, Health Literacy Theory, and Social Cognitive Theory. The Health Belief Model explains how mothers' perceptions of their children's susceptibility to growth and nutritional problems, perceived severity of growth abnormalities, perceived benefits of regular growth monitoring, perceived barriers, self-efficacy, and cues to action may influence their participation in growth-monitoring services. Health Literacy Theory emphasizes mothers' ability to obtain, understand, interpret, and apply information from growth-monitoring records, growth charts, healthcare providers, and other reliable sources. Social Cognitive Theory emphasizes observational learning, behavioural modelling, maternal self-efficacy, reinforcement, and social support in developing and maintaining appropriate child growth-monitoring practices. Collectively, these theoretical perspectives provide a suitable framework for explaining how growth-monitoring education may influence child growth-monitoring practices among mothers in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise mothers or primary caregivers of children aged 0–59 months residing in selected urban, semi-urban, and rural communities across Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, local government areas, communities, households, primary healthcare centres, and eligible mothers. Growth-monitoring education will be assessed using indicators such as exposure to educational sessions, frequency and duration of education, information on child growth and development, recommended growth-monitoring schedules, anthropometric measurements, interpretation of growth charts, recognition of growth faltering, undernutrition and overweight, appropriate child feeding, nutrition counselling, immunization and preventive healthcare, follow-up requirements, and situations requiring professional assessment. Child growth-monitoring practices will be assessed using indicators such as attendance at scheduled growth-monitoring sessions, regular presentation of children for weight and length or height assessment, retention and use of child health records, understanding and interpretation of growth charts, adherence to recommended follow-up appointments, participation in nutrition counselling, appropriate response to abnormal growth findings, and healthcare-seeking when growth concerns are identified. Data will be collected using structured questionnaires, standardized growth-monitoring knowledge and practice assessment tools, child health records or growth-monitoring cards where available and ethically accessible, healthcare-facility registers where appropriate, and pre-test and post-test assessments where a quasi-experimental intervention is adopted. Descriptive statistics will be used to summarize mothers' demographic and socioeconomic characteristics, child characteristics, healthcare utilization patterns, sources of growth-monitoring information, and growth-monitoring practices. Inferential statistical techniques, including chi-square tests, paired and independent t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of growth-monitoring education on child growth-monitoring practices. Where a quasi-experimental design is adopted, growth-monitoring practice scores before and after the educational intervention may be compared with those of a comparison group to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that growth-monitoring education has a significant positive impact on child growth-monitoring practices among mothers of under-five children in Nigeria. Mothers exposed to structured, practical, evidence-based, and culturally appropriate growth-monitoring education are expected to demonstrate greater participation in recommended growth-monitoring activities than mothers without comparable exposure. Education may improve mothers' understanding of the importance of regular growth assessment, recommended monitoring schedules, growth charts, nutritional counselling, and appropriate responses to abnormal growth patterns. Practical education may also improve mothers' ability to interpret growth-monitoring information and recognize when a child requires further nutritional or medical assessment. Improved knowledge may encourage mothers to retain child health records, attend scheduled appointments, follow healthcare recommendations, and seek timely professional care when growth concerns are identified. However, financial constraints, transportation difficulties, long waiting times at health facilities, competing household responsibilities, limited availability of growth-monitoring services, inadequate healthcare personnel, cultural beliefs, and poor continuity of care may reduce the effectiveness of education alone. The study therefore expects accessible, practical, repeated, and community-supported growth-monitoring education, integrated with quality child-health services, to contribute significantly to improved child growth-monitoring practices among mothers in Nigeria. The study is expected to contribute to the literature on child growth monitoring, maternal health education, child nutrition, under-five health, growth assessment, malnutrition prevention, health literacy, primary healthcare, maternal and child health, and public health in Nigeria. 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 centres, hospitals, nurses, midwives, nutritionists, community health workers, maternal and child-health programmes, development partners, and policymakers regarding strategies for strengthening routine child growth monitoring. The study will also provide evidence-based recommendations for integrating growth-monitoring education into routine maternal and child-health services, improving mothers' ability to interpret growth charts, strengthening nutrition counselling and follow-up systems, improving the availability and accessibility of growth-monitoring services, enhancing healthcare-worker communication, and developing sustainable community-based interventions that promote regular growth monitoring and early identification of growth and nutritional problems among under-five children across Nigeria.

Keywords: Growth-monitoring education, child growth-monitoring practices, mothers, under-five children, growth monitoring, growth charts, child nutrition, malnutrition prevention, maternal health education, primary healthcare, Nigeria, public health.