Growth monitoring and promotion program services utilization patterns between home-based and facility-based delivery methods: A comparative analysis

Abstract

Background In Bangladesh, utilization of government health facility-based growth monitoring and promotion (GMP) services is notably low, prompting non-governmental organizations (NGOs) to collaborate with the government to enhance GMP service utilization through home-based delivery. Despite this, there is limited information available on home-based GMP service utilization. This study aimed to investigate the utilization of GMP services between home-based and facility-based programs and identifying key factors and barriers to caregiver engagement with GMP services in rural Bangladesh. Methods A descriptive mixed-method study was conducted across six sub-districts from August to December 2019. Three sub-districts with home-based GMP services provided by NGOs were compared with three neighboring sub-districts offering government facility-based GMP services. A total of 3038 randomly selected mothers and children under one year old were included in the quantitative part of the study. Quantitative surveys include information on household socio-demographic information, GMP service components, knowledge, utilization, barriers, and qualitative approaches were used for data collection on caregivers and service providers perspectives on GMP services. Descriptive statistics were conducted for sociodemographic characteristics, caregivers’ knowledge, perception and barriers to utilization of GMP services. Student’s t-tests and chi-square tests were used to compare quantitative and qualitative variables between both GMP arms. Risk ratios (RR) with 95% confidence intervals were calculated to compare GMP knowledge. Simple logistic regression identified GMP service use levels and related barriers. Multiple logistic regression was employed to determine statistically significant associations between GMP utilization and independent variables such as caregivers who heard about GMP or GMP cards, were members of an NGO, and lacked interest in GMP services at p-value <0.05 and adjusted risk ratio (ARR) values. Thematic analysis of qualitative data was performed. Results were triangulated across sources. Results Children’s average age was 9.8 months, with a 1:1 male-to-female ratio in both groups (home-based vs. facility-based: 51.9% vs. 50.0%). Home-based GMP services exhibited higher utilization rates, with more children receiving weight and length measurements and caregivers receiving counseling than facility-based services (40% vs. 0% utilization, respectively). Caregivers’ utilization of GMP services in home-based areas was positively influenced by their knowledge of GMP or GMP cards (Adjusted risk ratio, ARR: 37.4) and their involvement with an NGO, association, or health program (ARR: 1.3). Caregivers in home-based GMP areas relied on NGO staff for service delivery, while those in facility-based areas reported no outreach from government health workers and lacked access to GMP cards due to supply issues. Across both areas, low awareness of GMP services and the absence of incentives contributed to limited utilization. Conclusion GMP service utilization remains low in rural Mymensingh district of Bangladesh. Home-based GMP service utilization was 40% but none of the caregivers utilized facility-based GMP services. Higher utilization in home-based areas was linked to caregiver awareness, access to GMP cards, and NGO involvement, while key barriers included lack of government outreach, supply gaps, and absence of incentives. To improve GMP coverage, government programs should enhance community level outreach, ensure consistent supply of growth cards, and consider integrating small incentives to motivate caregivers.