Nutritional services for children in Beira, Mozambique: a study reporting on participatory use of data to generate quality improvement recommendations

Abstract

BackgroundExisting literature suggest frequent gaps in the quality of care (QoC) provided to children with malnutrition in low-income and middle-income countries. Beira is the second largest city in Mozambique. This study included two phases: phase 1 was a systematic assessment of the QoC provided to malnourished children in Beira; phase 2 aimed at using findings of the assessment to develop recommendations, with a participatory approach, to improve QoC.MethodsIn phase 1, all facilities offering nutritional care to children in Beira were included, and exit health outcomes were reviewed against international SPHERE standards. A sample of four (66%) facilities was randomly selected for a comprehensive assessment of all areas contributing to QoC using an adapted WHO tool. In phase 2, key stakeholders were identified, and using a participatory approach, a list of actions for improving the QoC for malnourished children was agreed.ResultsIn phase 1, outcomes of 1428 children with either severe acute malnutrition or moderate acute malnutrition (MAM) were reviewed. In-hospital recovery rate (70.1%) was almost in line with the SPHERE standard (75%), while at outpatient level, it was significantly lower (48.2%, risk ratio (RR) 0.68, p<0.0001). Recovery rate was significantly lower in HIV seropositive compared with seronegative (39.2% vs 52.8%, RR 1.34, p=0.005). High heterogeneity in MAM recovery rate was detected among facilities (range 32.5%–61.0%). Overall, out of all domains contributing to QoC in the sample, 28/46 (60.8%) indicated suboptimal care with significant health hazards and 13/46 (28.2%) indicated totally inadequate care with severe health hazards. In phase 2, a list of 38 actions to improve QoC for malnourished children was agreed among 33 local and national stakeholders.ConclusionsLarge heterogeneity in QoC for malnourished children in Beria was detected. The study documents a concrete example of using data proactively, for agreeing actions to improve QoC.

Quality of healthcare for children with severe acute malnutrition in a refugee setting: cross-sectional study in West Nile Region, Uganda

“…However, following major investments in prevention and control, HIV prevalence among children in Uganda is currently estimated to be relatively low (0.5%), 31 with an observed prevalence in malnourished children in West Nile Region of around 2.4%, 17 significantly lower than that reported in other nearby countries. 32 Additionally, studies have reported that the health status of refugees can be quite variable even within nearby areas, and volatile within a short time frame, due to multiple factors including population type and place of origin, local conditions like water and hygiene sanitation, existing protection services like distribution of food rations, and treatment services such as access to healthcare and availability of drugs and therapeutic foods. 2 4-7 The influence of all these factors on the final outcomes of refugee children with malnutrition should be better evaluated in future prospective studies.…”

Structural readiness of health facilities in Mozambique: how is Mozambique positioned to deliver nutrition-specific interventions to women and children?

“…Similar to other studies on nutrition in Mozambique, our results demonstrate that there are gaps in the Mozambican health system related to the availability and provision of items at health facilities required for adequate delivery of maternal and child nutrition interventions. [37][38][39] We also found that many health facilities offer maternal and child nutri- • Population with access to a health facility-refers to the population that lives within 10 kilometers of any health facility that is ready to deliver nutrition services.…”

Use of collaborative learning approach for increased cure rate among children aged 6–59 months with severe wasting in Karamoja, Uganda

“…CR is a proportion of patients successfully discharged as cured during the reporting period, of which discharges include cured, defaulters, deaths and non-respondents. Within Uganda, the CR in OTC is reported to be between 52.9% in Arua and 71.5% in Karamoja, 13 14 which is below the Sphere humanitarian standard of 75%. 15 …”

“…In Mozambique, CR among children with wasting managed in the health facilities was 48.2%. 13 CR among children managed in OTC in Ethiopia ranges from 61.8% to 79.6%. [17][18][19][20][21] Although CR in Karamoja improved in 2013-2016 (71.5%), 22 it was below the standard 75%.…”

“…Mwanza et al 16 reported CR of 80% in OTC in Zambia. In Mozambique, CR among children with wasting managed in the health facilities was 48.2% 13. CR among children managed in OTC in Ethiopia ranges from 61.8% to 79.6% 17–21.…”