Factors leading to missed opportunities in diagnosis and management of acute malnutrition in children less than 5 years at Wakiso Health Centre IV

Abstract

Acute malnutrition is one of the major causes of morbidity and mortality among under-five children in Sub-Saharan Africa in general and Uganda in particular but it’s often missed as a diagnosis in most general medical set ups. To understand the causes of failure to diagnose acute malnutrition a study was carried out at Wakiso Health Center IV in Wakiso district which is located in Central Uganda and greater Kampala and a total of 121 respondents were involved in the study The source of data was through an administered questionnaire which was extracted out of the standard Ministry of Health Monitoring and Evaluation tool. The Nutrition Service Delivery Assessment (NSDA) of September 2015. The questionnaire was used to assess all child health care delivery points for their feasibility and ability of health workers to detect acute malnutrition. And to determine the prevalence of acute malnutrition amongst children below 5 years who receive health care at Wakiso health center IV. Among the respondents 61% were female and 39% were male and respondents between 6months to 5 years formed 80% while those below 6 months formed 20%. A sample screening and assessment for malnutrition was done among the respondents and 96.7% had normal nutrition status and 3.6% had acute malnutrition way above the regional average of 2.1%. The study found out that lack of logistics and instruments used in screening and assessment on nutritional status, lack of up to date literature, incomplete physical examination and lack of training in management of acute malnutrition led to missed opportunities in diagnosis and management of acute malnutrition. Recommendations and ways forward suggested the following. Diagnostic equipment and tools required in the management of acute malnutrition should be prioritized amongst other items when requesting for health facility supplies. Clinical staff need training in the use of some diagnostic equipment for acute malnutrition like 2 in 1 weighing scale and Z score charts. The clinical staff should ensure complete history taking from any credible source when in contact with patients so as to source out nutrition and feeding problems. The clinical staff should try to do complete physical medical-nutrition examinations when in contact with patients despite the patient turn up and flow rate so as to find out nutrition problems which may co-exist with medical problems. The health facility administration should try to found the staff with up to date literature like the current IMAM guidelines of 2016 and necessary training and continuous education in order to reduce the knowledge gap existing in the diagnosis and management of acute malnutrition. The facility administration should demonstrate a demand for a nutrition professional at the facility amongst the health center staffing. This can be done in conjunction with the District Health Officer (DHO) in conjunction with the political leadership.