ASSESSMENT OF CAREGIVERS' KNOWLEDGE, RETENTION AND UTILIZATION OF CHILD HEALTH CARDS IN OYO STATE, NIGERIA: A MIXED METHOD STUDY WITH A CONVERGENT DESIGN.

Background: The "Child health card" (CHC) is integral to monitoring a child's growth and assessing development to support the early detection of malnutrition and prompt intervention. CHC is also valuable in keeping track of a child's vaccinations. There are limited studies on knowledge and utilization of CHC in Oyo state, Nigeria. We therefore aimed to assess caregiver's knowledge, retention, and utilization of child health cards in Ibadan, Oyo State, Nigeria. Methods: A community-based mixed-method study using a parallel convergent design was employed. Quantitative data were collected from 617 caregivers at their compounds in the selected communities using an interviewer-administered questionnaire. Qualitative data were collected by interviewing caregivers and healthcare workers at health facilities. Bivariate analysis of quantitative indicators and thematic analysis of qualitative interviews were conducted. Results: Caregiver knowledge of the CHC, including the contents of the CHC and growth charts, was poor, but retention was relatively high (69.6%). Retention of the CHC was higher among caregivers whose index child was <12 months (p=0.011) and among those with good knowledge of the CHC (p<0.001). Being employed (p=0.016), having tertiary education (p=0.027), having good knowledge (p<0.001), and good perception of the CHC (p=0.001) were positively associated with the utilization of CHC. We found that when caregivers failed to present the card at immunization clinics, they often faced verbal reprimands from healthcare workers, and in some cases, their child's vaccination was denied. Conclusion: CHC retention was high despite low utilization by caregivers. Therefore, interventions designed to improve community awareness of the CHC could provide an opportunity to improve the use of child health cards in this setting.