Quality-Adjusted Coverage of Nutrition Interventions Across the Continuum of Care: Insights from Household and Health Facility Data in Bangladesh

Abstract

Abstract Objectives Improving the impact of nutrition interventions requires adequate measurement of both reach and quality of interventions, but limited evidence exists on advancing coverage measurement. We adjust crude health coverage estimates, taking into consideration the inputs required to deliver quality nutrition services, across the continuum of care in Bangladesh. Methods We used data from Bangladesh Demographic and Health Surveys 2014 to assess use of maternal and child health services and Service Provision Assessments 2014 to determine facility readiness to deliver nutrition interventions during antenatal (ANC), institutional delivery, and postnatal care (PNC). Service readiness was computed as the mean availability of four nutrition-specific inputs, capturing human resources and training, equipment, diagnostics, and medicines. Crude coverage was combined with service readiness to create a measure of input-adjusted nutrition coverage at the national and regional levels, across place of residence, and by maternal educational and household socio-economic quintiles. Results Crude coverage varied, with greater use of any ANC (79%) and postnatal care (61–81%), than institutional delivery (37%). Nutrition service readiness was lower than crude coverage at each time point, such that nutrition input-adjusted coverage was 45% for ANC, 25% for institutional delivery, and 38–49% for preventive and sick child postnatal care, respectively. Input-adjusted coverage varied by 10–22 percentage points (pp) between regions within the country. Inequalities in input-adjusted coverage were large during ANC and institutional delivery (12–17 pp between urban and rural areas, ∼17pp between low and high education, and 30–36pp between highest and lowest wealth quintiles), and less variable for postnatal care (<10%). Conclusions Nutrition input-adjusted coverage was suboptimal and varied sub-nationally and across the continuum of care in Bangladesh. Special efforts are needed to improve the reach as well as the quality of health and nutrition services to achieve the Sustainable Development Goals. Funding Sources Bill & Melinda Gates Foundation through A4NH.