Perspectives for integration into the local health system of community-based management of acute malnutrition in children under 5 years: a qualitative study in Bangladesh

Nutrition Journal

Research

Anne Dominique Israël¹  Cécile Salpéteur¹  Myriam Aït Aïssa¹  Hans J Ebbing²  Valery Ridde³  Camille Eric Kouam⁴  Hélène Delisle⁴ 

[1] Nutrition & Health Service, Action Against Hunger France (ACF-France), 4 rue Niepce - PARIS CEDEX 14, 75662, Paris, France;Nutrition & Health Service, Action Against Hunger France (ACF-France), House - 20, Rd- 117, Gulshan 2, 1212, Dhaka, Bangladesh;School of Public Health, CRCHUM, Faculty of Medicine, University of Montreal, Saint-Antoine Tower, 850 Saint-Denis, 3rd Floor, Room S03-462, H2X 0A9, Montreal, Quebec, Canada;TRANSNUT - (WHO Collaborating Centre on Nutrition Changes and Development), Department of Nutrition, Faculty of Medicine, University of Montreal, Chemin de la Côte Sainte-Catherine,H3T 1A8, 2405, Montreal, Quebec, Canada;

关键词: Acute malnutrition;    Under-5 children;    Community-based management of acute malnutrition;    Preparedness;    Health system;    Bangladesh;   

DOI  :  10.1186/1475-2891-13-22

 received in 2013-07-21, accepted in 2014-03-12,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundAcute malnutrition is a major cause of death among under-five children in low- and middle-income countries. United Nations agencies recommend the integration of community-based management of acute malnutrition (CMAM) into the local health systems for sustainability. The objective of the study was to assess the preparedness of the health system to implement CMAM targeting children under-five years in two sub-districts of Bangladesh.MethodsThe assessment was performed through direct observation of 44 health centres, individual interviews of seven policy makers, three donors, four health and nutrition implementing partners, 29 health workers, and review of secondary data. Assessment themes, derived from the WHO six Building Blocks, were nutrition governance, nutrition financing, health service delivery, human resources, equipment and supply, referral, monitoring and supervision mechanism. They were subdivided into 16 criteria. Findings were compared with CMAM operational recommendations according to WHO, Valid International and Food and Nutrition Technical Assistance guidelines.ResultsThe government of Bangladesh has developed inpatient and outpatient CMAM guidelines, and a policy offering free-of-charge health care for under-five children. Nutrition coordination was not under full government leadership. Most of funds (74%) dedicated to CMAM were provided by donors, for short-term interventions. Of the total 44 health centres assessed, 39 (88.6%) were active, among which 4 (10.2%) delivered inpatient services, 35 (89.8%) outpatient services, and 24 (61.5%) outreach services. These were regarded as opportunities to include CMAM activities. There were 48.9% vacant positions and the health workers were not trained for management of acute malnutrition. Equipment and supplies did not meet the operational recommendations for management of acute malnutrition.ConclusionImplementing CMAM through the health centres of both sub-districts would warrant progressive strengthening of the overall health system in the light of identified barriers. A short term strategy would consist of strengthening government coordination of nutrition interventions, exploring additional funding sources, equipping and supplying functional health centres, training health workers and actively involving community health workers to cope with health facility staff shortage. A mid-term strategy would consist of securing permanent funding for CMAM, rehabilitating non-functional health centres, attracting and retaining health workers in rural areas.

【 授权许可】

CC BY   
© Kouam et al.; licensee BioMed Central Ltd. 2014