Introduction: The aim of the study was to assess the quality of the management of severe acute malnutrition in the Mono Departmental Hospital Center (CHD) in Benin. Methods: This was a cross-sectional and evaluative study which took place from 03 February to 20 July 2016. The study was carried out in the mono departmental hospital of Lokossa. The non-probabilistic sampling method was used to select all our study materials and all our targets were systematically selected. Our study materials involved observation checklist, guidelines documents and questionnaires to collect data. The assessment of the quality of the hospital management of severe acute malnutrition was based on national and international standards like Benin’s national protocol of acute malnutrition management. Results: In our study, 27 cases of severe acute malnutrition (SAM) in children were considered. The median age of those children was 12 months. The rates of the components inputs, process and results were 25% (poor), 58.33% (acceptable) and 40% (poor), respectively. The sub components with respect to the norms were all related to the management of severe acute malnutrition like, availability of therapeutic foods ready for use, availability of management protocol, availability of trained and supervised staff in the management of the severe acute malnutrition and the proportion of dead and cured children. The study showed that the quality of the management of severe acute malnutrition at the mono departmental hospital of Lokossa was poor with a rate of 41.38%. Conclusion: The quality of the management of severe acute malnutrition at the mono departmental hospital of Lokossa was poor. The sub components that need to improve were the availability of therapeutic foods ready for use, availability of management protocol, along with the training and supervision of staff in charge of the management of severe acute malnutrition.
In developing countries, child malnutrition is still one of the main causes of child death and a major public health problem [
As a departmental hospital, the skills in care and services in accordance with the “protocol for the management of acute malnutrition in Benin” should ensure effective management of SAM. Adequate interventions in the management of SAM are required in order to reduce related mortality in children under 5 years of age. The purpose of the study was to assess the quality of the management of severe acute malnutrition in the mono Departmental Hospital Center (CHD) in Lokossa.
Our study was conducted at the Mono CHD of Lokossa in pediatric service. The town of Lokossa located in the South-West of Benin is 110 miles from Cotonou. The hospital provides care and services to the department of Mono and Couffo, the population of which is estimated or esteemed to 1.242.571 inhabitants, with 197.567 children under five years of age according to the 2012 census or enumeration. The prevalence of SAM was respectively 2.2% and 5% in the Couffo and Mono departments in 2014 [
This was a cross-sectional and evaluative study which took place from 03 February to 20 July 2016. The study population and material included:
ü children under 5 years of age admitted to the Mono departmental hospital for severe acute malnutrition;
ü health professionals involved in the management of SAM in the pediatric ward;
ü mothers of children with SAM admitted in the hospital during the period of 1 to 30 June 2016;
ü medical records of children under 5 admitted to CHD Mono for severe acute malnutrition.
v Inclusion criteria
Following subjects were included in the study:
ü children under 5 years of age admitted to the Mono departmental hospital for severe acute malnutrition;
ü health professionals involved in the management of SAM in the pediatric ward;
ü mothers of children with SAM admitted in the hospital during the period of 1 to 30 June 2016.
v Exclusion criteria
Health professionals involved in the management of SAM in the pediatric service for less than one month were excluded from the study.
The non-probabilistic sampling method was used to identify participants and material that were systematically selected.
The sample of participants included 6 health professionals of the pediatric service, 27 children with SAM and 8 mothers of children with SAM within the period from 1st till 30 June 2016.
For the operational aspects of the variables, we adapted our rating scale and appreciation to the one proposed by Myriam Hubinon [
But for variables with more than one assessment criteria, the score awarded to the variable was 1 if more than 75% of the expected criteria were met and 0 if less than 75% of expected outcomes were observed.
In accordance with the protocol, the components were qualified as:
・ good if the score was more than or equal to 75% of the score expected,
・ bad if the score was less than 75% of the score expected.
The means and tools used to collect data were; interview from the head of the pediatric department and questionnaires for health professionals based on their qualification, training and knowledge in the management of SAM.
Direct observation was used to assess the working environment (medical and technical equipment, the availability of therapeutic foods, medicines, technical support, and health professional skills) and information about anthropometric data and treatment were assessed from the reports and medical records or files of children admitted for SAM.
Two investigators were hired and trained about data collection sheets and tools as well as how to employ the method of work. Data collection was supervised by a student at the end of the training of Master’s Program in Nutrition.
The approval of the hospital was obtained prior to any action. An oral consent was obtained from all the targets before any data collection. That consent claimed that targets may withdraw their participation in the study at any time without any risk. Anonymity and confidentiality of the information were also ensured.
Variables | Effective | % |
---|---|---|
Sex | ||
Female | 9 | 33.33 |
Male | 18 | 66.66 |
Admission diagnosis | ||
Severe acute malnutrition | 3 | 11.11 |
Marasmus | 2 | 7.40 |
Severe malaria and severe acute malnutrition | 22 | 81.48 |
Variables | Observed score | Score expected | Frequency (%) |
---|---|---|---|
Environment resources | 0 | 1 | 25* |
Therapeutic foods | 0 | 1 | 0 |
Essential drugs | 1 | 1 | 100 |
Anthropometric and medico-technic assessment | 1 | 1 | 80** |
Nutritional education materials | 0 | 1 | 0 |
Management tools | 1 | 1 | 80** |
Departmental advice comity | 0 | 1 | 0 |
Qualified staff | 0 | 1 | 50*** |
Trained staff | 0 | 1 | 0 |
Nutritionist | 0 | 1 | 0 |
Supervised staff | 0 | 1 | 0 |
Normative documents of MAS | 0 | 1 | 0 |
Total | 3 | 12 | 25 |
*: One modality (lighting) on 4 (lighting, propriety, ventilation, privacy) was wright; 25% < 75%; so score was “0”; **: 4 on 5 anthropometric material were availability; 80% > 75% so the score is “1”; ***: 6/12 health professionals were qualified; 50% < 75% so the score is “1”.
Variables | Observed score | Score expected | Frequency (%) |
---|---|---|---|
Service organization | |||
Hours of services | 1 | 1 | 83* |
Continuity of services | 1 | 1 | 100 |
RCR¹ system | 1 | 1 | 100 |
Hosting | 1 | 1 | 86** |
Staff skills | |||
Knowledge | 0 | 1 | 43 |
Abilities | 1 | 1 | 81*** |
Attitudes | 1 | 1 | 87**** |
Aptitudes | 0 | 1 | 0 |
Practices | 0 | 1 | 60 |
Interpersonal communication | |||
counseling | 0 | 1 | 0 |
Motivational interview | 0 | 1 | 0 |
Nutritional advice registration | 1 | 1 | 100 |
Total | 7 | 12 | 58.33 |
*: 10 of 12 health professional were on time; that is 83% > 75% so the score is 1 point; **: 6 steps on 7 were respected in hosting process (acronym BERCER); that is 86% > 75% so the score is 1 point; ***: All the steps were not effective; that explain the point of score (1 point); ¹: Reference_Contre_Reference.
Variables | Observed score | Score expected | Frequency (%) |
---|---|---|---|
Proportion of healed children | 0 | 1 | 25.92* |
Proportion of children referred for better care | 1 | 1 | 100 |
Proportion of children who died | 0 | 1 | 22.22** |
Patient satisfaction | 1 | 1 | 88*** |
Staff satisfaction | 0 | 1 | 0 |
Total | 2 | 5 | 40 |
*:7 out of 27 children were healed; that was 25. 92% < 75% so the score is 0 point; **: 6out of 27 children were died; 22. 22% < 75% so the score is 0 point; ***: Only one client out of 8 in the focus group was not satisfied; 88% > 75% that explain the point of the score.
appreciation of the component was rated poor. The scores for this component are summarized in the
To assess the quality of the management of SAM in children in Mono departmental hospital, the components inputs, process and results were rated. The final score showed that the quality of the management of severe acute malnutrition was poor.
Similar studies of Savadogo et al. [
Bambara showed in his study on nutritional surveillance that 79.07% of health professionals had been supervised in the management of SAM [
Components | Quality score (%) | Appreciation |
---|---|---|
Inputs | 25 | Poor |
Process | 58.33 | Poor |
Results | 40 | Poor |
Total | 41.38 | Poor |
Quality of the management of severe acute malnutrition at the mono departmental hospital was poor 41.38% (under 75%).
The results concerning knowledge and skills in the SAM management are different from those obtained by Testa et al. in their study [
The results obtained from the practical assistance of health professional were different from those obtained by Aouehougon et al. in their study conducted in the health district of Tougan [
The proportion of healed children was different from the one obtained by Hossain et al. in 2016, where they 88% of children cured from SAM [
The proportion of children who died was different from the results obtained by Hossain M. et al. and Nguefack et al. Their results were 10.19% and 21.9% respectively. These differences could be explained by their respective sizes of the samples which were 138 and 41 participants. In the study of Savadogo et al., 16% children were observed who died [
The result concerning the satisfaction of mothers was different from the one found by Kiemde et al. in their study in Banfora, Burkina Faso, showing 32% of non-satisfaction. The main reason mentioned was the use of the same pant to assess the weight of SAM children. This difference could be explained by the fact that in our study, a scale with the double weighing was used to assess children’s weight [
In a study, Bitwe et al. [
One of the limitations of this study is that since the study took place in only one hospital, so the results are not applicable for all the hospitals in the country. Variables were scored between 0 and 1. Despite these limitations, the study brought useful results to improve the SAM management in hospitals.
The quality of the management of severe acute malnutrition at the mono departmental hospital of Lokossa in Benin was observed to be poor. The sub components that need to improve were availability of therapeutic foods ready for use, availability of management protocol, the training and supervision of staff in charge of the management of severe acute malnutrition and best practices of health professional. Specific and sensible interventions are required to avoid severe and irreversible consequences of malnutrition in children.
Kenao, T.S., Sossa Jerome, C., Glèlè Ahanhanzo, Y., Sopoh, G.E., Makoutodé, P. and Agueh, V.D. (2017) Evaluation of the Quality of Hospital-Based Management of Severe Acute Malnutrition in Children under 5 in Benin. Food and Nutrition Sciences, 8, 1012-1021. https://doi.org/10.4236/fns.2017.811073