National Health Research Authority, Ministry of Health, Lusaka, Zambia.
Doctor of Public Health Program, Boston University School of Public Health, Boston, Massachusetts, United States of America.
PLoS One. 2020 May 12;15(5):e0232663. doi: 10.1371/journal.pone.0232663. eCollection 2020.
Malnutrition 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.
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. 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.
We 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.
This 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.
营养不良在赞比亚仍是一个主要的公共卫生挑战。为了有效应对这一挑战，卫生系统必须得到有力加强，以提供有效的连续护理。本文研究了与五岁以下儿童营养支持相关的卫生系统问题和服务，以确定差距，并提出普及基本营养服务的干预措施。
本分析利用了一项关于与五岁以下儿童严重急性营养不良（SAM）相关因素的横断面混合方法研究的数据，以评估赞比亚十个省份中五个省份的一级医院提供的营养服务。使用 Stata 版本 13 进行分析。我们进行了单变量分析，以评估提供的营养服务、设备和工具的功能、人力资源的可用性及其人力资源开发、以及用于评估和管理与营养相关的健康结果的药物的可用性。
我们发现，不同地区和省份提供的营养服务水平存在很大差异。抽样的所有医院中有 88%提供团体营养咨询，92%的医院为其客户提供个体营养咨询。总体而言，社区志愿人员与医院之间转诊和反向转诊系统的存在率在所有评估的服务中最低，分别为 48%和 58%。我们还发现，除了卫生部建议的营养师外，所有职级的人力资源数量都不足。
这项研究揭示了卫生系统和卫生服务提供方面存在的一些差距，需要加以解决；最突出的是，缺乏工具、政策和指南、药品和卫生专家，以帮助照顾营养不良的婴儿和儿童。我们的研究结果还表明，在严重急性营养不良的管理中，社区和卫生机构之间的转诊系统不足。要在赞比亚实现营养服务的普及，就需要更多地关注这项研究中发现的卫生系统问题。
