Experiences of health care professionals working with childhood malnutrition in the Xhariep District, Free State

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De Figueiredo, Natasha Alexandra Bico
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University of the Free State
Introduction: Childhood malnutrition remains a global health crisis where more than 149 million children are stunted. The rate of childhood malnutrition is a persistent issue in South Africa, where many challenges exist regarding management. Priority nutrition interventions aimed at lessening the burden of malnutrition have been identified; however, several challenges hamper progress in achieving the country’s goal to reduce the prevalence of malnutrition. By identifying the experiences of health care professionals, who treat childhood malnutrition daily at an operational level, their experiences can be recorded, and aid policy makers understand the factors that presently affect the management of malnutrition from the health professionals’ perspectives. Aim: This study aims to describe the experiences of health care professionals during the management of childhood malnutrition. Methods: The study followed a typical descriptive design using a qualitative approach. Six healthcare professionals (two doctors, two registered dietitians, and two professional nurses) who work with childhood malnutrition in the Xhariep District were identified and included in the study. Open-ended questions were asked in semi-structured one-on-one narrative interviews conducted with each participant, following an interview protocol. Every interview was audio recorded with informed consent. Data were coded, grouped into categories, and then further organized into themes. Results: The majority of the participants work at district hospital facilities; however, services are still rendered to primary health care facilities using community outreaches. Participants showed a general understanding of the term malnutrition with an inclination towards the immediate causes thereof. Substance abuse, caregivers’ lack of knowledge, and social problems and economic constraints were the common perceptions of why childhood malnutrition is still high in South Africa. Recurring challenges experienced by the health care professionals with the treatment of childhood malnutrition included: lack of medical and human resources, uncooperative patients, mismanagement by staff and emotional burdens. To overcome these challenges, participants mentioned: availing additional assistance for patients, engaging community support, sourcing other supplementation stock, promoting education and health campaigns, and acquiring more human resources as methods and solutions. The general opinion regarding the protocols and programs currently in place to help treat childhood malnutrition is that they are good and valuable. If implemented correctly, it improves the patient’s health significantly. However, most participants felt that the implementation and lack of human and financial resources cause the protocols and programs to fail. Conclusion and Recommendations: Although the participants came from three different components with varying responsibilities within the health system, they all experienced similar challenges. A pattern resulting from the cascade of these challenges was noted, which stemmed from financial constraints. With limited financial resources allocated at primary health institutions, stock and human resources availability is negatively impacted, which leads to poor service delivery. Patients who do not receive adequate quality health care are left unsupported and uninformed, which can factor caregivers of children with malnutrition to neglect their responsibilities, ultimately resulting in a persistent decline of the child’s health and nutritional status. The quality-of-service delivery at public health facilities correlates with the rate of malnutrition in South Africa. To decrease the rate of childhood malnutrition, policies need to be revised to greatly improve the quality of care patients receive at public health facilities.
Dissertation (M.Sc. (Nutrition and Dietetics))--University of the Free State, 2021, Malnutrition, Severe acute malnutrition, South Africa, Qualitative research, Lived experiences, Primary health care, Rural