To estimate the impact of fish farming operated at household level on nutritional status among children 6-59 months of age, a cross-sectional study was conducted in Zomba district, Malawi. Anthropometric measurements of 66 children in each type of household (fish-farming and non-fish-farming households) and structured interviews with their parents were undertaken. A total of 21 background variables were employed and examined using bivariate and multivariate analyses. Overall, a lower prevalence of malnutrition was detected among the children in fish-farming households than those in non-fish-farming households in all the malnutrition indicators, i.e. stunting, underweight and wasting. In particular, a significantly lower prevalence was detected among the children in fish-farming households than those in non-fish-farming households in both severe (P=0.045) and global underweight (P=0.042). 'Higher proportion of income from fish farming to total income', 'more frequent intake of oil and fats other than never/seldom' and 'breastfeeding practice for the appropriate duration' are the protective factors against being underweight. Household fish farming may have indirectly contributed to lower prevalence of underweight through increasing frequency of intake of oil and fats by strengthening households' purchasing power. The study supports 12 months as the threshold for appropriate breastfeeding duration.
To improve the quality of the health services provided, it is better to include indicators on the quality of care in the PBF scheme. Mutual co-operation between PBF models and technical assistance may ensure better service quality while boosting the quantity. A robust but feasible data validation mechanism should be in place, as a PBF could incentivize inaccurate reporting. The capacity for financial management should be strengthened in PBF recipient ODs. To address the broader aspects of MNCH, a balanced input of resources and strengthening of all six building blocks of a health system are necessary.
Background In 2006, the countries of the Association of Southeast Asian Nations (ASEAN) signed the Mutual Recognition Arrangements (MRA) in relation to nursing services in the region. This agreement was part of a set of policies to promote the free flow of skilled labor among ASEAN members and required mutually acceptable professional regulatory frameworks. This paper presents a narrative review of the literature to (1) describe progress in the development of the regulatory framework for nursing professionals in Cambodia and Vietnam since 2000 and (2) identify key factors, including the MRA, that affect these processes. Methods For document review, policy documents, laws, regulations, and published peer-reviewed and gray literature were reviewed. Data were triangulated and analyzed using a tool developed by adapting McCarthy et al.’s regulatory function framework and covering eight functions (legislation, accreditation of preservice education, competency assessment, registration and licensing system, tools and data flow of registration, scope of practice, continuing professional development, professional misconduct and disciplinary powers). Results Cambodia and Vietnam have made remarkable progress in developing their regulatory frameworks for nursing. A number of key influences contributed to the development of nursing regulations, including the signing of the MRA in 2006 and the establishment of the Joint Coordinating Committee on Nursing (AJCCN) in 2007 as key milestones. Macroeconomic and political factors affecting the process were economic growth and an emerging private sector, social demand for quality care and professionalism, global attention to health workforce competencies, the role of development partners, and regular monitoring and mutual learning through AJCCN. A period of incubation enabled countries to develop consensus among stakeholders regarding regulatory arrangements; this trend accelerated after 2010 by bringing national regulatory schemes into conformity with the regional framework. Some similarities in the process (e.g., preservice education first, legislation later) and differences in key actors (e.g., professional councils and the capacity of nursing leaders) were observed in two countries. Conclusion Further development of the regulatory framework will require strong nursing leadership to sustain achievements and drive continued progress. The adapted tool to assess regulatory capacity works well and may be of value in assessing the development of regulations in the nursing profession. Electronic supplementary material The online version of this article (10.1186/s12960-019-0388-y) contains supplementary material, which is available to authorized users.
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