Towards universal coverage for nutrition services in children under five years-A descriptive analysis of the capacity of level one hospitals to provide nutrition services in five provinces of Zambia

• Published in: PloS one 2020-05, Vol.15 (5), p.e0232663-e0232663
• Main Authors: Banda, Kutha, Chilengi-Sakala, Sandra, Chunga, Chipwaila Choolwe, Solomon, Hiwote, Chalwe, Victor, Nkaama, Justine Mweene, Leonard, Colleen, Bobo, Mupeta, Aongola, Agness, Biemba, Godfrey
• Format: Article
• Language: English
• Subjects: Availability; Biology and Life Sciences; Care and treatment; Child health; Child health services; Child malnutrition; Children; Drug development; Drugs; Engineering and Technology; Health care facilities; Health care reform; Health facilities; Health services; Hospital facilities; Hospitals; Human nutrition; Human resources; Infants; Malnutrition; Management; Medical research; Medically uninsured persons; Medicine and Health Sciences; Nutrition; Patient care; People and Places; Provinces; Public health; Public health movements; Resource development; Resource management; Studies; System effectiveness
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0232663

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.