Service Availability and Readiness Assessment of Facility-Based Management of Severe Acute Malnutrition in Children in a Public Healthcare Setting in Jorhat, Assam.

backgroundWasting is one of the most concerning growth and development issues in India, as in other parts of the world. Such children require carefully calibrated nutrition, together with management of co-morbidities. Both community and facility-based management are available for addressing the problem. Nutrition rehabilitation centres (NRCs) have been set up at health facilities in many districts to provide interventional measures to those malnourished children who require facility-based care. However, effective management of a case at the facility level with limited resources is always a challenge.

objectivesTo assess the service availability and readiness of facility-based management of children with severe acute malnutrition (SAM) in an NRC of Jorhat, and to identify the opportunities and barriers to facility-based management of SAM children. MATERIALS AND

methodsA descriptive (exploratory) qualitative study was done in the NRC of Jorhat for a period of six months, including six key informants and 12 caregivers. The data were collected through key informant interviews (KIIs) and in-depth interviews (IDIs) using semi-structured KII and IDI guides, as well as an observation guide to collect data on facility readiness, which was done by both observation and interview methods. Thematic analysis was done through inductive coding.

resultThe facility had a deficiency of helper/attendant and medical social worker (MSW) and lacked resuscitation and suction equipment. No separate sleeping arrangements were present for the caregivers. Other than these, sufficient ward equipment, kitchen, and pharmacy supplies were present. The major opportunities observed were the support from the medical college administration and the district health administration. The strength was a functioning NRC with dedicated staff. The major challenges from the facility side were a shortage of supporting staff and a shortage of some emergency equipment. From the beneficiary side, the major challenges were long duration of stay, financial loss, and poor nutritional awareness.

conclusionThe present study has highlighted various challenges, both from the healthcare provider and beneficiary side, involving diverse areas such as human resources, financial issues, essential supplies, workload, nutritional awareness, and time constraints. However, all the beneficiaries expressed satisfaction with the services in the NRC.