[Evaluation of the quality of screening and management of infant malnutrition in Cotonou, Benin].
Evaluation de la qualité du dépistage et de la prise en charge de la malnutrition infantile à Cotonou (Bénin)
Résumé
The purpose of this study was to evaluate the quality of screening and management of infant-juvenile malnutrition in medical/social centres in Cotonou, Benin, the nation's capital and largest city. Study was carried out in 19 public and private medical/social centres selected on the basis of their nutritional activity. Data was collected using 5 methods, i.e., retrospective review of the each centre's records, evaluation of physical resources available at each centre, observation of care providers (n=90), questionnaire concerning nutritional activities for the person in charge of each centre (n=19), and questionnaire about care for the mothers of children consulting at the centres (n=43). The overall prevalence of malnourished children identified by screening at the medical/social centres was low (2.2 %) in comparison with the prevalence of malnutrition in Cotonou (20.3 %). Less than half of the centres (47.4 %) used growth charts. None of the centres had a "thinness chart". Many centres (28.6 %) used material intended for cooking demonstrations. Most centres (75 %) conducted effective Information Education and Communication (IEC) sessions and all authorized centres had required essential medications on hand. Observation of care providers showed that 35% could not perform basic anthropometric measurements. Use of growth charts was lowest among physicians and medical assistants. No doctor provided nutritional counselling. Based on responses to the questionnaire the general knowledge of care providers was good despite the lack of supervision and continuous education. Analysis of the responses of the mothers who brought their children to the centres indicated that malnutrition was never the initial reason for seeking medical attention and only 39 % understood that their child was malnourished upon leaving the centre. These findings indicate that the quality of screening and management of infant-juvenile malnutrition in Cotonou is poor. There is a need to develop a program to fight malnutrition which is a major health problem in the city. Special measures will be necessary for the urban setting.
La présente étude tente d’évaluer la qualité du dépistage et de la prise en charge des enfants malnutris dans les centres socio-sanitaires de Cotonou, ville la plus importante du Bénin. Elle a pu être réalisée dans 19 centres privés, publics, médicaux et sociaux. Cinq enquêtes ont été nécessaires : une enquête rétrospective à partir des registres des centres, une évaluation des moyens matériels dont disposait chaque centre, une enquête d’observation des prestataires de soins (n=90), un questionnaire du responsable des activités nutritionnelles de chaque centre (n=19), un questionnaire des mères des enfants malnutris venus consulter dans ces centres (n=43). La prévalence globale des enfants malnutris dépistés dans les centres socio-sanitaires était très faible (2,2%) par rapport à la prévalence de la malnutrition à Cotonou (20,3%). Moins de la moitié des centres (47,4%) utilisaient une fiche de suivi de croissance. Aucun ne possédait de diagramme de maigreur [...]