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Table 3 Gaps in quality of nutritional services observed by capacity area

From: Quality of care for children with acute malnutrition at health center level in Uganda: a cross sectional study in West Nile region during the refugee crisis

Capacity area Observed issue
Organisation of services Nutrition services delivered “under the tree”
Working hours unclear
Frequent service delays if rain
No triage
Chaotic organisation, no clear roles and responsibilities
No transport for children sent In-patient Therapeutic Care (ITC)
Working hours unclear
Case management Triage not performed
Mid Upper Aram Circumference (MUAC) not routinely done at all entry points (Out patients department -OPD, Tuberculosis and Anti retroviral therapy - TB/ART)
Mis-classification SAM/MAM
Z-score never used (only MUAC used)
No history taking
Comprehensive clinical examination as per the Integrated Management of Childhood Illnesses (IMCI) not performed
Treatment Water with sugar not offered at admission
10 key messages on RUTF not delivered
Individual counselling never performed
Amoxicillin, vitamine A, Iron and mebendazole not prescribed
MAM and SAM usually treated the same
Integrated Management of childhood Illnesses (IMCI) HIV status often indicated as unknown despite availability of testing kits
TB rarely assessed
Children at OPD not always assessed for nutritional status
Children with malnutrition not assessed according to IMCI
Staff working in out-patient care not trained in IMCI
Old IMCI job aids in some facilities
Supplies Stock out of RUTF observed in many facilities
Lack of mean of transport to facilities
Lack of timely request from facilities
Staffing Lack of staffing with some facilities having no nutritional focal person appointed
Lack of nutritional specific training
Poor practices even among trained staff
Village Health Teams (VHTs) usually not formally trained but doing the job at OTC in place of facility staff
Community linkage VHTs screening reports not readily available
Blank VHTs registers
No effective means of communication between facilities and village health teams (VHTs)
No incentives for the VHT
Quality improvement Several supportive supervision activities are conducted on a quarterly basis, at facilities but only few are specific to nutrition
  1. Abbreviations: ART Anti Retro-viral Therapy, HIV Human Immune-deficiency Virus, IMCI Integrated Management of Childhood Illness, ITC In-patient Therapeutic Care, MAM Moderate Acute Malnutrition, MUAC Mid-Upper Arm Circumference, OPD Out Patients Department, OTC Out-patient Therapeutic Care, RUTF Ready-to-Use Therapeutic Foods, SAM Severe Acute Malnutrition, TB Tuberculosis, VHT Village Health Teams