Center for Research in Evaluation and Surveys, National Institute of Public Health, Cuernavaca, Mexico.
Health Department, Universidad Iberoamericana, Mexico City, Mexico.
Int J Equity Health. 2024 Feb 22;23(1):35. doi: 10.1186/s12939-024-02129-z.
Maternal and child malnutrition represents a public health problem in Mexico Primary care (PC) is responsible for introducing women and children under five to the health system, detecting diseases on time, and providing medical services, including pharmacological treatment if necessary. Providing these services with quality is essential to improve maternal and child health. This study evaluated the quality of nutritional care during preconception, pregnancy, postpartum, infancy, and preschool age at the PC health units across six Mexican states between 2020 and 2021.
We conducted a cross-sectional study with a mixed approach in units of the Secretary of Health to assess the quality of nutritional care during preconception, pregnancy, postpartum, childhood, and preschool age. The level of quality was calculated by the percentage of compliance with 16 indicators that integrated a Quality Index of Maternal and Child Nutritional Care (ICANMI, by its Spanish acronym). Compliance by indicator, by life stage, and overall was categorized using the following cut-off points: poor quality (≤ 70%), insufficient quality (71-89%), and good quality (≥ 90%). The perceptions of the barriers and facilitators that affect maternal and child nutrition were evaluated through semi-structured interviews with health professionals (HP) and users. All qualitative instruments were developed with a gender and intercultural perspective.
Considering the whole sample studied, maternal and child nutritional care quality during the five life stages evaluated was bad (compliance: ≤12%), reflected in the ICANMI, which had a compliance of 8.3%. Principal barriers identified to providing high-quality nutritional care were the lack of knowledge and training of health professionals, shortages of equipment, medicine, personnel, and materials, the disappearance of the social cash transfer program Prospera, the absence of local indigenous language translators to support communication between doctor and patient, and the persistence of machismo and other practices of control over women.
These findings underscore the need for initiatives to improve the quality of nutritional care in PC facilities across Chihuahua, State of Mexico, Veracruz, Oaxaca, Chiapas, and Yucatan. It is necessary for government and health authorities, along with various stakeholders, to collaboratively devise, implement, and assess intercultural and gender-oriented policies and programs geared towards ensuring the health infrastructure and enhancing the training of health professionals to diagnose and treat the prevalence and occurrence of diverse forms of malnutrition in both maternal and child populations.
母婴营养不良是墨西哥的一个公共卫生问题。初级保健（PC）负责将妇女和五岁以下儿童引入卫生系统，及时发现疾病，并提供医疗服务，包括必要时的药物治疗。提供高质量的服务对于改善母婴健康至关重要。本研究评估了 2020 年至 2021 年期间，墨西哥六个州的 PC 卫生单位在孕前、妊娠、产后、婴儿期和学龄前期间进行营养护理的质量。
我们采用混合方法在卫生部门的单位进行了一项横断面研究，以评估孕前、妊娠、产后、儿童和学龄前期间营养护理的质量。通过整合母婴营养护理质量指数（ICANMI）的 16 项指标的依从性计算质量水平。通过以下截止值对指标、生命阶段和整体的依从性进行分类：质量差（≤70%）、质量不足（71-89%）和质量好（≥90%）。通过与卫生专业人员（HP）和使用者进行半结构化访谈，评估影响母婴营养的障碍和促进因素的看法。所有定性工具均从性别和跨文化角度开发。
考虑到整个研究样本，评估的五个生命阶段的母婴营养护理质量都很差（依从性：≤12%），反映在 ICANMI 中，其依从性为 8.3%。提供高质量营养护理的主要障碍是卫生专业人员缺乏知识和培训、设备、药品、人员和材料短缺、Prospera 社会现金转移计划的消失、缺乏当地土著语言翻译以支持医患之间的沟通，以及大男子主义和其他控制妇女的做法的持续存在。
这些发现强调了需要在奇瓦瓦州、墨西哥州、韦拉克鲁斯州、瓦哈卡州、恰帕斯州和尤卡坦州的 PC 设施中采取措施提高营养护理质量。政府和卫生当局以及各利益攸关方需要共同制定、实施和评估面向跨文化和性别的政策和方案，以确保卫生基础设施，并加强卫生专业人员的培训，以诊断和治疗母婴人群中各种形式的营养不良的流行和发生。
Zotero 插件