Health, Nutrition and Population, The World Bank Group, Washington, District of Columbia, USA
Health, Nutrition and Population, The World Bank Group, Washington, District of Columbia, USA.
BMJ Open. 2023 Feb 28;13(2):e064819. doi: 10.1136/bmjopen-2022-064819.
To assess the competence of primary healthcare (PHC) providers in delivering maternal and child nutrition services at the PHC level and patients' experience in receiving the recommended components of care.
Observational cross-sectional analysis.
Healthcare facilities in low/middle-income countries (LMICs) with available service provision assessment surveys (Afghanistan (2018), Democratic Republic of Congo (2018), Haiti (2017), Kenya (2010), Malawi (2013-2014), Namibia (2009), Nepal (2015), Rwanda (2007), Senegal (2018), Tanzania (2015) and Uganda (2007).
18 644 antenatal visits and 23 262 sick child visits in 8458 facilities across 130 subnational areas in 11 LMICs from 2007 to 2019.
(1) Provider competence assessed as the direct observations of actions performed during antenatal care (ANC) and sick child visits; and (2) patients' experience defined as the self-reported awareness of the nutrition services received during ANC and sick child visits and provider effectiveness in delivering these services.
Except for DRC, all countries scored below 50% on patients' experience and provider competence. More than 70% of clients were advised on taking iron supplements during pregnancy; however, less than 32% of patients were advised on iron side effects in all the studied countries. Across all countries, providers commonly took anthropometric measurements of expectant mothers and children; however, such assessments were rarely followed up with advice or counselling about growth patterns. In addition, less than 20% of observed providers advised on early/immediate breast feeding in all countries with available data.
The 11 assessed countries demonstrated the delivery of limited nutrition services; nonetheless, the apparent deficiency in the extent and depth of questions asked for the majority of tracer activities revealed significant opportunities for improving the quality of nutrition service delivery at the PHC level.
评估初级医疗保健（PHC）提供者在 PHC 层面提供母婴营养服务的能力以及患者接受推荐护理内容的体验。
观察性横断面分析。
在具有服务提供评估调查的中低收入国家（LMIC）的医疗保健设施中，这些国家包括阿富汗（2018 年）、刚果民主共和国（2018 年）、海地（2017 年）、肯尼亚（2010 年）、马拉维（2013-2014 年）、纳米比亚（2009 年）、尼泊尔（2015 年）、卢旺达（2007 年）、塞内加尔（2018 年）、坦桑尼亚（2015 年）和乌干达（2007 年）。
2007 年至 2019 年期间，11 个中低收入国家的 130 个次国家地区的 8458 个设施共 18644 次产前检查和 23262 次患病儿童检查。
（1）提供者能力评估为在产前保健（ANC）和患病儿童就诊期间直接观察到的操作；（2）患者体验定义为自我报告的在 ANC 和患病儿童就诊期间接受的营养服务意识以及提供者提供这些服务的有效性。
除了刚果民主共和国外，所有国家在患者体验和提供者能力方面的得分都低于 50%。超过 70%的孕妇在怀孕期间被建议服用铁补充剂；然而，在所有研究的国家中，不到 32%的患者被建议服用铁的副作用。在所有国家，提供者通常对孕妇和儿童进行人体测量；然而，这种评估很少跟进关于生长模式的建议或咨询。此外，在所有有可用数据的国家中，不到 20%的观察到的提供者建议尽早/立即进行母乳喂养。
评估的 11 个国家提供了有限的营养服务；尽管如此，大多数示踪剂活动的问题提出的范围和深度明显不足，这为改善初级医疗保健层面的营养服务提供质量提供了重要机会。
