1.1. Background
The wide-ranging, quality acute malnutrition treatment health care services are important for promoting and maintaining under-five child health, preventing and managing hasty recent weight loss and growth faltering, morbidity, and premature death(1).In the year 2016, 80,060 of 400, 000 estimated severe acute malnutrition(SAM) children had faced medical complications and it was time for the need of intensive lifesaving medical treatments in health facility-based therapeutic feedings; alongside 1.7 million moderately acute malnutrition (MAM) pregnant and lactating mothers needed access to emergency health services(2). Globally, about 55 million children under the age of five suffer from acute malnutrition; 19 million of these suffer from the most serious type of severe acute malnutrition. Every year, 3.1 million children die of malnutrition(3).
The problem of acute malnutrition treatment delay is aggravated by poor infrastructure and accessibility of treatment services. As pointed out in Nigeria, about 39% of the population access health facility within one hour walk during the dry season, and it decreased to 24% during the wet season due to poor infrastructure which accounts for 90% of non-paved roads to access the treatment services(4). Due to this and different factors, in 2015, it was estimated that 50 million under-five children were affected by acute malnutrition globally and the highest rates of under nutrition were reported in Africa, Asia, and Oceania(5).
Although Ethiopia had designed a new guideline for acute malnutrition treatment to increase the access and coverage of the services (9), evidence showed that only 3 out of every 10 of all episodes of underweight received proper health attention for treatment which articulates the treatment service is low and it contributes for 24% of all child mortality (10). Additionally, evidence showed that there was a high admission rate for under-five children in Ethiopia (11). Thus, exploring barriers that delay parents/caregivers for acute malnutrition treatment can contribute to disclose the barriers and provide evidence-based decisions in a healthy structure and the community that can help to scale-up the access and coverage of acute malnutrition treatment services(6).
The trends of the global prevalence of childhood underweight are estimated to decreasing in all parts of the world. However, the case is projected in increasing fashion in Sub-Saharan, Eastern, Middle, and Western Africa. This trend alerts the world and Africa that are not on the track of achieving malnutrition reduction(7). It is evidenced that twelve African countries have very high levels of childhood underweight which contributes to the insignificant change of child malnutrition reduction in that Ethiopia is one of the affected countries with a high level of childhood malnutrition(7).
Similarly, the service provider for acute malnutrition treatment among under-five children hindered and Amhara regional state accounts high prevalence of under-weight and poor nutritional status. The high admission rate, bed occupancy, and length of stay indicated the higher the delay or the lower cure rate for treatment (8–10). Lay Gaynet is also one of the highly affected districts by nutritional problems in the region that the Growth Through Nutrition project is running to reduce malnutrition problems though the problem is not significantly reduced yet (11).
There are different concurrent and conflicting perspectives on the problem and it was the clinical assortment that was considered as a disease perception in the community rather than viewing under nutrition as a disease. In that case, parents/caregivers were unlikely to behave to consult health workers if the child was lone thin(12–14). Again, parents'/caregivers ‘health-seeking behaviours on accessing the service of acute malnutrition are also poor(15). The provision of health education and promotion, counselling on beliefs, motivation and awareness creation(16), linear child growth interpretation had not guided by nutrition and health system programming which had dominated by community norms; additionally, there is a need for early identification of acute malnutrition (17, 19). Even though the services for acute malnutrition in every allopathic health facility had said to be delivered, the attendance for treatment remains low in the country(16). Though studies assured the low service utilization quantitatively, still there is a huge gap in knowing barriers of acute treatment in health facilities(17–20).
Again, qualitative research is rarely done to explore the barriers in the study area. Consequently, knowing the detail is critical to have evidence-based intervention against the barriers for missing the mark on acute malnutrition treatment among under-five children.
Thus, this study aimed to explore barriers that delay acute malnutrition treatment among under-five children in Lay Gaynet, Northwest Ethiopia.
Even though exploring barriers for acute malnutrition treatment/care delay among parents/caregivers having under-five children (0–59 months) is a key factor for the reduction of acute malnutrition, morbidity, and mortality, little is known about the current factors influencing the utilization of acute malnutrition treatment services early in allopathic health facilities. Although different factors were identified for the reason of care delay, most of the studies were quantitative studies, they were not done in the study area, they might be different in socio-economic, cultural and other related issues, availability of the service and understandings of the problem might be different. Again, qualitative research was rarely done to explore the barriers in the study area. Similarly, this qualitative study was conducted from the time and place context of acute malnutrition treatment. Therefore, to have detailed understandings of the reason for treatment delayed to intervene in the problem with an evidence-based approach this qualitative content analysis study was done. Consequently, knowing the detail is critical to have evidence-based intervention against the barriers for missing the mark on acute malnutrition treatment among under-five children.
This qualitative study is, therefore, aimed at filling the gaps, by attempting to explore details of the barriers for acute malnutrition treatment/care services delay among parents having under-five children.
Therefore, different stakeholders could utilize the finding of this study for a holistic approach and designing their evidence-based intervention strategy for advocacy, health education and promotion, nutritional counselling, and community mobilization.
In our study of this descriptive qualitative content analysis, we thought to answer the questions listed below with probing questions;
-
Reasons for delay in seeking acute malnutrition care (AMC)?
-
Reasons for delay in reaching Acute malnutrition care (AMC)?
-
Reasons for delay in receiving adequate Acute malnutrition care (AMC)?