Understanding of growth monitoring charts by literate and illiterate mothers in northeast Brazil.

Abstract

Growth failure secondary to malnutrition occurs with a high prevalence in the developing world. Growth monitoring (GM) is one of the key primary health care strategies for controlling this problem. To assess the impact of literacy on the ability to interpret growth monitoring information the understanding of sample growth charts was evaluated among mothers in two communities of Fortaleza where growth monitoring programs had been promoted for several years. Homes were sequentially visited to identify families with children under 5 years of age who had a growth chart showing at least one weight recorded in the previous 12 months. These mothers were then interviewed by a public health nurse and asked to interpret six sets of growth charts portraying data on fictitious children from 6 to 17 months of age. The growth chart was that of the Ministry of Health which included lines for the 10th and 90th percentiles. Scores from 0 to 6 were given based on the number of correct responses given. 64 (45%) of the 142 mothers included in the study were classified as illiterate. Illiterate mothers tended to be older to have more children and a greater proportion lived in one of the two communities. No significant differences were seen in percentage of surviving children proportion of mothers working outside the home and family income. Illiterate mothers showed a higher frequency of participation in GM sessions. The results of the individual questions of the evaluation indicated mean scores for literate and illiterate mothers of 4.5 (SD 1.4) and 3.2 (SD 1.8) respectively (p < 0.001). If four correct answers were used as an arbitrary cut-off for a satisfactory level of understanding 85% and 53% of literate and illiterate mothers respectively achieved this mark. Among illiterate mothers community of residence and attendance at all GM sessions were significantly associated with the mean scores. Among literate mothers age (25-34 years) was significantly associated with higher mean scores.