Nutritional services for children in Beira, Mozambique: a study reporting on participatory use of data to generate quality improvement recommendations

[摘要] Background Existing literature suggest frequent gapsin the quality of care (QoC) provided to children withmalnutrition in low-income and middle-income countries.Beira is the second largest city in Mozambique. Thisstudy included two phases: phase 1 was a systematicassessment of the QoC provided to malnourishedchildren in Beira; phase 2 aimed at using findings ofthe assessment to develop recommendations, with aparticipatory approach, to improve QoC.Methods In phase 1, all facilities offering nutritionalcare to children in Beira were included, and exit healthoutcomes were reviewed against international SPHEREstandards. A sample of four (66%) facilities was randomlyselected for a comprehensive assessment of all areascontributing to QoC using an adapted WHO tool. In phase 2,key stakeholders were identified, and using a participatoryapproach, a list of actions for improving the QoC formalnourished children was agreed.Results In phase 1, outcomes of 1428 children with eithersevere acute malnutrition or moderate acute malnutrition(MAM) were reviewed. In-hospital recovery rate (70.1%)was almost in line with the SPHERE standard (75%), whileat outpatient level, it was significantly lower (48.2%, riskratio (RR) 0.68, p<0.0001). Recovery rate was significantlylower in HIV seropositive compared with seronegative(39.2% vs 52.8%, RR 1.34, p=0.005). High heterogeneityin MAM recovery rate was detected among facilities (range32.5%–61.0%). Overall, out of all domains contributing toQoC in the sample, 28/46 (60.8%) indicated suboptimalcare with significant health hazards and 13/46 (28.2%)indicated totally inadequate care with severe healthhazards. In phase 2, a list of 38 actions to improve QoCfor malnourished children was agreed among 33 local andnational stakeholders.Conclusions Large heterogeneity in QoC for malnourishedchildren in Beria was detected. The study documents aconcrete example of using data proactively, for agreeingactions to improve QoC.

[学科分类] 药学