Abstract
BackgroundMalnutrition continues to be a major public health challenge in Zambia. To effectively address this, health systems must be well strengthened to deliver an effective continuum of care. This paper examines health systems issues and services in relation to nutritional support to children under five years, in order to identify gaps and propose interventions towards universal coverage of essential nutrition services.MethodsThis analysis utilized data from a cross sectional mixed-methods study on factors associated with Severe Acute Malnutrition (SAM) in under-five children to assess health facility nutrition services on offer at select level-one hospitals in five out of ten provinces in Zambia. Stata version 13 was used for analysis. We conducted univariate analysis to assess nutrition services offered, functionality of equipment and tools, availability of human resource and human resource development, and availability of drugs used for assessment and management of nutrition-related health outcomes.ResultsWe found large variations in the level of nutrition services on offer across districts and provinces. Eighty-eight percent of all the hospitals sampled provided group nutrition counseling and 92% of the hospitals in our sample offered individual nutrition counseling to their clients. Overall, the existence of referral and counter-referral systems between the Community Based Volunteers and hospitals were the lowest among all services assessed at 48% and 58% respectively. We also found inadequate numbers of human resource across all cadres with an exception of nutritionists as recommended by the Ministry of Health.ConclusionsThis study has revealed a number of gaps in the health system and health service delivery that requires to be addressed; most notably, a lack of tools, policies and guidelines, drugs and health specialists to help care for malnourished infants and children. Our findings also reveal inadequate referral systems between the community and health facilities in the management of severe acute malnutrition. Achieving universal coverage for nutrition services in Zambia will require a lot more attention to the health systems issues found in this study.
Highlights
Introduction and rationaleMalnutrition remains a global public health challenge, especially among children under five years, with close to half (45%) of all deaths in this age group linked to malnutrition [1]
This analysis utilized data from a cross sectional mixed-methods study on factors associated with Severe Acute Malnutrition (SAM) in under-five children to assess health facility nutrition services on offer at select level-one hospitals in five out of ten provinces in Zambia
Our findings reveal inadequate referral systems between the community and health facilities in the management of severe acute malnutrition
Summary
Introduction and rationaleMalnutrition remains a global public health challenge, especially among children under five years, with close to half (45%) of all deaths in this age group linked to malnutrition [1]. In 2018, a joint report by the United Nations Children’s Fund (UNICEF), World Health Organization, and the World Bank highlighted the slow progress that has been made in reducing the prevalence of undernutrition in under-5 children [2]. In 2016, the United Nations (UN) General Assembly declared 2016 to 2025 the UN Decade of Action on Nutrition [1] This Decade of Action called for policy actions across six areas including aligning health systems to nutrition needs and providing universal coverage of essential nutrition interventions. The joint report by the United Nations Children’s Fund (UNICEF), World Health Organization, and the World Bank report found 58.8 million under-5 children living in Africa were stunted, 14 million were classified as wasting, and 9.5 million were overweight [2]. This paper examines health systems issues and services in relation to nutritional support to children under five years, in order to identify gaps and propose interventions towards universal coverage of essential nutrition services
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