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

Abstract

Objectives5.0 million annual deaths in low-income and middle-income countries are due to poor quality of care (QOC). We evaluated the QOC provided to malnourished children in West Nile Region in Uganda.DesignCross-sectional study.SettingWest Nile Region, an area hosting over one million refugees.ParticipantsAmong 148 facilities providing nutritional services, 30 randomly selected facilities (20%) and the records of 1467 children with severe acute malnutrition (100% of those attending the 30 facilities during last year) were assessed.OutcomesThe national Nutrition Service Delivery Assessment (NSDA) tool was used to assess capacity areas related to QOC. Case management, data quality and health outcomes were assessed from official health records. Multivariate analysis was performed to explore factors significantly associated with better cure rates.ResultsOf 305 NSDA scores allocated to 30 participating centres, 201 (65.9%) were ‘good’ or ‘excellent’. However, 20 (66.7%) facilities had ‘poor’ ‘quality improvement mechanisms’ and 13 (43.3%) had ‘poor’ ‘human resources’. Overall data quality in official records was poor, while recorded quality of case management was overall fair. Average cure rate was significantly lower than international Sphere standards (50.4% vs 75% p<0.001) with a higher default rate (23.2% vs 15% p<0.001). Large heterogeneity among facilities was detected for all indicators. Refugee-hosting and non-refugee-hosting facilities had a similar cure rate (47.1% vs 52.1%) though transfer rates were higher for those hosting refugees (21.5% vs 1.9%, p<0.001) despite better ‘equipment and supplies’. ‘Good/excellent’ ‘equipment’ and ‘store management’ were significantly associated with better cure rates in outpatient therapeutic centres (+55.9, p<0.001; +65.4, p=0.041, respectively) in multivariate analysis.ConclusionsThough most NSDA capacity areas were rated good or excellent, health outcomes of malnourished children in West Nile Region, both in refugee-hosting and non-refugee-hosting facilities, are significantly below international standards. Effective and sustainable approaches to improve malnourished child health outcomes are needed.

Perceived quality of care for severe acute malnutrition management among caregivers of under-five children with severe acute malnutrition in Addis Ababa, Ethiopia, 2022: a mixed-method study

“…This was also supported by the qualitative study findings in which healthcare providers also admitted that the provision of quality care for the SAM management was not possible due to the lack of support and attention from higher levels of institutions, and lack of supplements, separate unit, laboratory facilities, and training, shortage of staffs. This finding was supported by earlier studies in Northwest Ethiopia, Bangladesh, Iran, Malawi, Ghana, and South Africa ( 3 , 14 , 40 , 46 – 50 ). However, unlike the findings of the earlier study in Northwest Ethiopia ( 6 ), which reported that urban residents were more likely to perceive the service quality as poor, this study found that urban residents were less likely to rate the service as low quality.…”

“…Countries' capacity to provide high-quality care for SAM management is determined by the availability of infrastructure and well-trained staff in public hospitals dedicated to the treatment of malnourished children ( 13 ). Poor quality of care (QOC) has been implicated as a major risk factor for high mortality across conditions, especially in low- and middle-income countries ( 14 ).…”

Humanitarian Food Assistance and Nutrition Outcomes among Refugees: A Historical Perspective

“…"Global Acute Malnutrition (GAM) prevalence in prevalence in children ranged from 4% to 12% among refugees and 5% to 11% in the hosting population in Uganda [31], and the GAM rate for children in settlement areas in Uganda is high, at 7.3 percent, with some of the highest rates found in the West Nile" [26]. "The burden of malnutrition among refugee children as compared to the children in host communities is high" [31]. Refugees mainly depend on food rations that are insufficient in quantity and variety.…”