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Primary healthcare readiness for nutritionally at-risk infants aged under 6 months: a facility-based survey in
Tabitha D van Immerzeel1,2, Indou Deme-Ly3, Maty Diagne-Camara4
1Cheikh Anta Diop University, Department Social Peadiatric Institute, BP 5005, Dakar, Senegal.
Insights
Primary healthcare facilities struggle to identify and treat malnourished infants under six months old. Key gaps in equipment and training hinder readiness, despite WHO guidelines recommending improved infant nutritional care.
Area of Science:
- Public Health
- Pediatrics
- Nutrition Science
Background:
- Infant malnutrition under six months (u6m) poses significant risks to child development.
- Global malnutrition guidelines emphasize primary care for infant nutritional assessment and management.
- Limited data exists on primary healthcare readiness for infant nutritional care.
Purpose of the Study:
- To evaluate primary healthcare facility readiness for managing nutritional care in infants under six months.
- To identify specific gaps in the implementation of the Management of small and nutritionally At-risk Infants (MAMI) program.
Main Methods:
- Adapted the Harmonized Health Facility Assessment (HHFA) tool to include MAMI-specific items.
- Collected data through healthcare provider interviews, observations, and register reviews across five care contact points.
- Assessed 342 items to calculate mean scores for general readiness and MAMI availability.
Main Results:
- Overall primary care readiness was 69.5%, with MAMI-specific readiness at 37.7%.
- Infrastructure and health workforce scored higher (72.0% and 60.7%), while equipment and training were low (32.5% and 22.3%).
- Infants were assessed frequently (53.6%) but rarely classified (15.2%) or adequately treated (38.2%) for malnutrition.
Conclusions:
- Significant gaps persist in primary care's capacity to classify and treat at-risk infants under six months.
- Essential areas for improvement include equipment, training, and consistent application of MAMI protocols.
- Opportunities exist within existing care contact points to enhance WHO-recommended infant nutritional care.
Background:
Malnutrition in infants aged <6 mo (u6m) is poorly identified and managed in many countries, increasing the risk of poor growth and development. Addressing this gap, 2023 WHO malnutrition guidelines recommend assessment, classification and treatment at primary care level. This study aimed to assess primary healthcare facility readiness for nutritional care in infants u6m.
Methods:
We adapted the Harmonized Health Facility Assessment (HHFA), adding items for Management of small and nutritionally At-risk Infants u6m and their Mothers (MAMI) at five care contact points. Our HHFA-MAMI tool captured 342 items using healthcare provider interviews, observations and registers data to calculate mean scores per area and median patient visits.
Results:
We surveyed 15 facilities in Senegal. General readiness scored 69.5%, MAMI availability and readiness 37.7%. Infrastructure (72.0%) and health workforce (60.7%) were available, while equipment (32.5%) and training (22.3%) scored low. Infants were frequently assessed (53.6%), not often classified (15.2%) as at risk, nor adequately treated (38.2%). Comparing contact points, delivery and sick child clinic scored highest in readiness, immunization in utilization.
Conclusions:
Primary care readiness gaps exist in classifying and treating at-risk infants u6m, equipment and training. We found opportunities at each of the five contact points to implement WHO-recommended care.
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