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Table 5 Side-by-side display of key quantitative and qualitative findings and implications for practice

From: Understanding why child welfare clinic attendance and growth of children in the nutrition surveillance programme is below target: lessons learnt from a mixed methods study in Ghana

Attribute Quantitative findings Qualitative findings Implications
Attendance to the growth monitoring and promotion programme - Mean annual attendance 6.0 ± 2.9 - Proportion meeting ≥6 visits: 46.8% - Proportion meeting the recommended ≥9 visits: 13.6% - Overall drop-out rate: 59.5% Attendance based on maternal age, parity, postpartum socio-cultural practices, financial constraints, irregular staff remuneration, delays, unprofessional staff behaviours, high premium on vaccinations & general misconceptions about GMP programme Increase home visitations and target the following mothers: teenagers, single parents, women above 40 years, and those with parity above four children
Change in weight-for-age z-score during participation and the determining factors WAZ of 69.1% of the children improved. Determinants: - Underweight at baseline (AOR:11.1, 95% CI:4.0–31.0) - ≥6 annual visits (AOR:2.2, 95% CI:1.1–4.1) ≥9 annual visits (AOR:4.7, 95% CI:1.4–15.1) Deterioration in growth attributed to drop-out rates from the GMP programme, inadequate counselling, ineffective staff-client rapport, communication lapses, emphasis on achieving meeting vaccinations to the neglect of the other components of the programme - Sensitization on contribution of routine growth monitoring and promotion to early child development and the dangers associated with unidentified growth faltering
Motivation to attend and level of satisfaction with service delivery - Motivators for attendance were knowledge of child’s growth status and child vaccination. - 31% (95% CI: 25–37) of mothers satisfied - 59% (95% CI: 52–65) of mothers dissatisfied with service delivery Satisfied as result of awareness of child’s growth and education provided on child care. Dissatisfaction resulted from: long waiting times; late start of clinic; uncomfortable clinic area, monies collected as services charges and negative staff attitude - Primary healthcare systems should be strengthened to improve service delivery by increasing availability and accessibility to the service; staff supervision, training and monitoring