Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Department of Reproductive Health and Nutrition, School of Public Health, College of Health Sciences, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
PLoS One. 2020 Dec 3;15(12):e0243240. doi: 10.1371/journal.pone.0243240. eCollection 2020.
Good nutrition and healthy growth during the first 1000days have lasting benefit throughout life. For this, equally important is the structural readiness of health facilities. However, structural readiness and nutrition services provision during the first 1000 days in Ethiopia is not well understood. The present study was part of a broader implementation research aimed at developing model nutrition districts by implementing evidence based, high impact and cost-effective package of nutrition interventions through the continuum of care. This study was aimed at assessing structural readiness of health facilities and the extent of nutrition service provision in the implementation districts.
This assessment was conducted in four districts of Ethiopia. We used mixed method; a quantitative study followed by qualitative exploration. The quantitative part of the study addressed two-dimensions, structural readiness and process of nutrition service delivery. The first dimension assessed attributes of context in which care is delivered by observing availability of essential logistics. The second dimension assessed the service provision through direct observation of care at different units of health facilities. For these dimensions, we conducted a total of 380 observations in 23 health centers and 33 health posts. The observations were conducted at the Integrated Management of Neonatal and Childhood Illnesses unit, immunization unit, Antenatal care unit and Postnatal care unit. The qualitative part included a total of 60 key informant interviews with key stakeholders and service providers.
We assessed structural readiness of 56 health facilities. Both quantitative and qualitative findings revealed poor structural readiness and gap in nutrition services provision. Health facilities lack essential logistics which was found to be more prominent at health posts compared to health centers. The process evaluation showed a critical missed opportunity for anthropometric assessment and preventive nutrition counselling at different contact points. This was particularly prominent at immunization unit (where only 16.4% of children had their weight measured and only 16.2% of mothers with children under six month of age were counselled about exclusive breastfeeding). Although 90.4% of pregnant women who came for antenatal care were prescribed iron and folic acid supplementation, only 57.7% were counselled about the benefit and 42.4% were counselled about the side effect. The qualitative findings showed major service provision bottlenecks including non-functionality of the existing district nutrition coordination body and technical committees, training gaps, staff shortage, high staff turnover resulting in work related burden, fatigue and poor motivation among service providers.
We found a considerable poor structural readiness and gaps in delivering integrated nutrition services with a significant missed opportunity in nutrition screening and counselling. Ensuring availability of logistics and improving access to training might improve delivery of nutrition services. In addition, ensuring adequate human resource might reduce missed opportunity and enable providers to provide a thorough preventive counselling service.
在最初的 1000 天里，良好的营养和健康成长对人的一生都有持久的益处。为此，卫生设施的结构准备同样重要。然而，埃塞俄比亚最初 1000 天的结构准备情况和营养服务提供情况并不清楚。本研究是更广泛实施研究的一部分，旨在通过在连续护理中实施基于证据、高影响力和具有成本效益的综合营养干预措施，开发营养示范区。本研究旨在评估实施地区的卫生机构的结构准备情况和营养服务提供情况。
这项评估在埃塞俄比亚的四个地区进行。我们使用了混合方法；定量研究后进行定性探索。定量研究的两个维度是结构准备和营养服务提供过程。第一个维度通过观察基本后勤物资的可用性，评估提供护理的背景属性。第二个维度通过直接观察不同卫生机构单位的护理情况来评估服务提供情况。对于这两个维度，我们在 23 个卫生中心和 33 个卫生所进行了总共 380 次观察。观察在新生儿和儿童期疾病综合管理、免疫、产前护理和产后护理单位进行。定性部分包括对主要利益攸关方和服务提供者进行了总共 60 次关键知情者访谈。
我们评估了 56 个卫生机构的结构准备情况。定量和定性的结果都显示，营养服务提供的结构准备情况很差，存在差距。卫生设施缺乏基本后勤物资，而卫生所的这种情况比卫生中心更为突出。过程评估显示，在不同接触点进行人体测量评估和预防营养咨询存在重大错失机会，这在免疫单位尤为明显（只有 16.4%的儿童体重得到测量，只有 16.2%的 6 个月以下儿童的母亲接受过关于纯母乳喂养的咨询）。虽然 90.4%的接受产前护理的孕妇被开了铁和叶酸补充剂，但只有 57.7%的孕妇接受了补充剂益处的咨询，42.4%的孕妇接受了补充剂副作用的咨询。定性研究结果显示，主要的服务提供瓶颈包括现有的地区营养协调机构和技术委员会功能失调、培训差距、人员短缺、高人员流动导致工作相关负担、服务提供者的疲劳和积极性下降。
我们发现，结构准备情况相当差，综合营养服务提供存在差距，营养筛查和咨询存在重大错失机会。确保后勤物资的供应和改善获取培训的机会可能会改善营养服务的提供。此外，确保充足的人力资源可以减少错失机会，并使提供者能够提供全面的预防咨询服务。
