Early deficits in childhood growth and development contribute to long-term
problems that can persist into adulthood, including poor psychosocial wellbeing and
reduced adult income. According to recent estimates, more than 200 million children
worldwide fail to reach their full developmental potential. Underdevelopment is
particularly widespread among children in Zambia; approximately 40% of Zambian
children under five years of age are stunted due, in large part, to widespread malnutrition.
It is a tremendous challenge for the public health care system in the country to address this
burden. In this thesis, I investigate the capacity of rural health workers in Southern
Province, Zambia to treat acute malnutrition among children under 5 years of age.
Data presented in this thesis were collected from several sources. Information
regarding current guidelines, trainings for treatment of acute malnutrition and supply chain
for supplemental nutritious and ready-to-use therapeutic foods were collected during key
informant interviews performed with nutritionists (n=4) and rural health workers (n=5) in
Lusaka and Southern Province, Zambia. Nutritionists working within the health care
system at the national, provincial and district levels were interviewed, as were rural health
workers selected from a sample of health centers. Information on child nutrition was
collected using 24-hour food recall questionnaires that were administered to mothers from
a sample of households (n=215) in Southern Province. Data were analyzed with qualitative
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and quantitative methods. Outcomes of interest included the following: capability of rural
health workers to address and treat acutely malnourished children; average daily
consumption of carbohydrate, protein and fruit containing meals and snacks among infants;
maternal perception of child growth and development as compared to other children of the
same age; and mothers’ satisfaction with nutrition information and services provided by
their local health centers.
The first key finding of this study was that only 40% of rural health workers had
been trained in the treatment of acute malnutrition within the last five years, while 100%
of nutritionists had received training within the last two years. The second key finding was
that infants six to 12 month old in the study sample were reported to have low protein and
high carbohydrate consumption. On average, children consumed protein 0.75 times per day
and carbohydrates 3.24 times per day. The third key finding was that mothers appeared to
overestimate the development of their children. Despite the high rate of childhood stunting
in the study sample (38%), 76% of mothers felt their child was the same height or taller
than other children of the same age and sex, and close to 75% of mothers felt their child
learned at the same speed as or quicker than other children of the same age and sex.
These findings suggest that there are currently inadequate resources and capabilities
within the Zambian health care system to properly manage the high rate of child
malnutrition and stunting in the country. In order to have a greater effect on the reduction
of stunting in children, efforts to better disseminate resources from the national level to the
rural health centers for the treatment of chronic and acute malnutrition should be
considered. Necessary resources include better access to trainings for rural health workers,
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anthropometric tools to measure levels of malnutrition and supplemental nutritious foods
or ready-to-use therapeutic foods to treat children who are moderately or severely
malnourished should be increased.