The structure and process quality of care and its determinant in the management of under-nutrition among underfive children attending public health facilities in Dar es salaam

Abstract

Background Globally under-nutrition has affected many children, it contributes to about one third of the eight million deaths among under-fives every year, Tanzania like many other developing countries suffers from the problem of malnutrition with about 42% of under-five children with chronic under-nutrition, also known as stunting. There have been several interventions conducted to reduce under-nutrition among children all over the World and Tanzania in particular, however within the past ten years the levels of nutrition status of children under five years in Tanzania has not shown much of a significant improvement rather the levels of stunting and wasting has increased significantly. The structural and process quality of care in health facilities plays an important role in the management of under-nutrition in health facilities but also provides a preventive health education to mothers and care givers, it is therefore imperative to explore the quality of core elements in the management of under-nutrition that may have resulted in the persistent high rates of under-nutrition in Tanzania Objective To determine the structure and process quality of care and its determinants in the management of under-nutrition among under-five children attending Public Health facilities in Dar es Salaam Design: Cross Sectional study Setting: The study was conducted in one district hospital, two health centers, and 17 dispensaries, in Kinondoni District in Dar es Salaam region. Methods: A total of 384 health care providers and 384 children aged 6 – 59 months were included in this study. Kinondoni District and District hospital were selected conveniently, xvi and health centres and dispensaries included in this study were randomly selected. Quantitative data was collected using a standardized questionnaire from health care workers. Anthropometric measurements were taken from children participants by the trained researchers and compared to measurements taken by the health care providers. Anthropometric data were converted to nutrition status values using Epi-Info ENA Ver. 3.5.1, 2008 (CDC, Atlanta, Georgia, USA) software, using WHO reference values. All data were analyzed using SPSS version 17(SPSS Inc., Chicago, Illinois, USA). The main outcome variable was the structure and process quality of care and its determinants in the management of under-nutrition. and the independent variables assessed included availability of equipment for taking anthropometric measurements, availability of human resource, availability of therapeutic foods, treatment guidelines and management of acute malnutrition. Results: All facilities had weighing scales and only a few had length boards, consequently length measurements were not adequately taken. As a result, the main nutrition status assessed was weight for age using Road to health care which was found mostly in dispensary levels. Few facilities had treatment guidelines and staff trained on the management of malnutrition. The only medication used for treatment of under-nutrition was Ready To Use Therapeutic Food (RUTF) found in a few health facilities. There was a significant mean difference between the assessments of under-nutrition done by the researchers compared to that done by the health care worker. Conclusion: The overall result of this study indicates that there is inadequate structure quality to facilitate screening, assessment, and management of under-nutrition at all levels of health facilities. Such health facilities also had a low number of trained personnel for the management of under-nutrition. There is also inaccuracy and inconsistence in practices of xvii taking anthropometric measurements This resulted in misdiagnosis of malnutrition and consequently poor quality of care given to children under fives.