Maternal and child health care providers' knowledge on nutrition protocols and quality of nutrition services in Tamale, Ghana
The purpose of this study was to determine accessibility of protocols, MCH service providers' knowledge on nutrition protocols and the quality and adequacy of nutrition actions they deliver in order to generate ideas and make recommendations that would improve nutrition component actions in MCH services in Tamale, Ghana. A cross sectional assessment ofMCH care providers' in government health care delivery institutions within and surrounding communities of Tamale was conducted. The target populations were the health care providers' and their clients' (pregnant and lactating women and young children). A simple random process was used to select 41 service providers and 28 health facilities across the six sub-districts of Tamale. Tools used in data collection were set of questionnaires, structured observation guides, and checklists on nutrition supplies available compared to the recommended amounts per service contact. Findings from the study revealed that the mean nutrition protocols accessible to service providers was 2.8, and ranged from 1 to 5. About 57.5% of service providers had access to adequate number of protocols whilst 42.5% had inadequate protocols. The mean protocol knowledge score was 15.1, which ranged from 4.5 to 25.5. In all, 44% and 56% respectively of service providers had low and high knowledge on protocols. The mean quality service score was 62.49, and ranged from 34 to 91.67. 63% and 37% of service providers delivered high and low quality nutrition services respectively. The distribution of service providers between the two levels of protocols accessibility, knowledge and quality of nutrition services were all statistically insignificant. However, the distribution of service providers delivering adequate and inadequate nutrition services was si~iticant ix (Chi-Square statistic 7.049, p = 0.008), A Likelihood ratio Chi-Square test between the associations of knowledge to the category of service providers' was significant (11.463, p ;: 0.003). There were significant correlations between service providers' knowledge and quality of nutrition services (0.645, p < 0.05); and between service providers' knowledge and adequacy of nutrition services (0.353, p = 0.024). Also significant was a correlation '1 between service providers' years of practice and quality of nutrition services (0.654, p < 0.05).,No significant association was found between the categories of service providers' and quality of nutrition services. Based on the study findings, the hypothesis that 'there is no significant difference in the quality of nutrition services between rural and urban health facilities' cannot be rejected. However, two hypotheses namely: 'Service providers' knowledge on protocols is not significantly associated with the quality of services'; and Service providers' years of practice have no significant effect on the service quality' are both rejected. In conclusion, protocols accessibility was adequate since more majority (57.7%) had access to adequate number of protocols. But the protocols were poorly distributed among the different categories of service providers. Community Health Nurses had very limited access to a variety of nutrition protocols even though they made contacts with the highest number of clients compared to Nurse-Midwives or Staff Nurses. There was inadequate knowledge on service protocols by service providers. Slight variation was observed in the proportions of knowledgeable service providers between the urban and rural health facilities. Nevertheless, that did not significantly affect quality service delivery between the two settings. However overall, there was low delivery of quality nutrition services. Factors that hindered service providers' from using protocols were inadequacies of x nutrition supplies service providers' poor knowledge on protocols and clients' noncompliance to treatment protocols. Some recommendations generated following the study findings are: l} Higher priority should be given to Community Health Nurses in the distribution '1 nutrition protocols. 2) Distribution of nutrition supplies should be consistently monitored. 3)" Forums should be created to enable service providers' opportunity discuss and share knowledge and information on current service delivery practices. 4) When planning and organizing in-service trainings, Community Health Nurses should be top priority.