Effective coverage of nutrition interventions across the continuum of care in Bangladesh: insights from nationwide cross-sectional household and health facility surveys

Abstract

IntroductionImproving the impact of nutrition interventions requires adequate measurement of both reach and quality of interventions, but limited evidence exists on advancing coverage measurement. We adjusted contact-based coverage estimates, taking into consideration the inputs required to deliver quality nutrition services, to calculate input-adjusted coverage of nutrition interventions across the continuum of care from pregnancy through early childhood in Bangladesh.MethodsWe used data from the 2014 Bangladesh Demographic and Health Surveys to assess use of maternal and child health services and the 2014 Service Provision Assessment to determine facility readiness to deliver nutrition interventions. Service readiness captured availability of nutrition-specific inputs (including human resources and training, equipment, diagnostics and medicines). Contact coverage was combined with service readiness to create a measure of input-adjusted coverage at the national and regional levels, across place of residence, and by maternal education and household socioeconomic quintiles.ResultsContact coverage varied from 28% for attending at least four ANC visits to 38% for institutional delivery, 35% for child growth monitoring and 81% for sick child care. Facilities demonstrated incomplete readiness for nutrition interventions, ranging from 48% to 51% across services. Nutrition input-adjusted coverage was suboptimal (18% for ANC, 23% for institutional delivery, 20% for child growth monitoring and 52% for sick child care) and varied between regions within the country. Inequalities in input-adjusted coverage were large during ANC and institutional delivery (14–17 percentage points (pp) between urban and rural areas, 15 pp between low and high education, and 28-34 pp between highest and lowest wealth quintiles) and less variable for sick child care (<2 pp).ConclusionNutrition input-adjusted coverage was suboptimal and varied subnationally and across the continuum of care in Bangladesh. Special efforts are needed to improve the reach as well as the quality of health and nutrition services to achieve the Sustainable Development Goals.

Patterns and determinants of effective coverage of routine maternal and newborn health visits in Nepal: Analysis of the 2016 Demographic and Health Survey

“…Poor EC of MNH visits identified in the current study are consistent with the studies conducted in Bangladesh [54], Cambodia [55], and other LMICs of South Asia and Sub Saharan Africa [18,46]. Studies conducted in Nepal reported poor quality of ANC [48] and had low uptake of recommended antenatal interventions (e.g., ANC counselling or iron or tetanus toxoid injections) [56].…”

A rapid systematic review and evidence synthesis of effective coverage measures and cascades for childbirth, newborn and child health in low- and middle-income countries

“…Overall 64 measures that met the eligibility criteria were reported across the 33 studies; 36 measures of interventions among women and newborns ( Table 3 ), 29 measures among children under five ( Table 4 ), and 0 measures for children ages five to nine. Seventeen studies explicitly defined the measures as effective coverage, three studies referred to measures as effective coverage but reported them according to the adjustments made: input-adjusted coverage [ 50 , 55 ] and structure-adjusted coverage and process-adjusted coverage [ 39 ]. The remaining studies did not use the term effective coverage, instead measures were defined as: adequate contact with high quality care [ 52 ], content coverage [ 36 ], coverage of obstetric services [ 32 ], facility readiness [ 48 ], high quality contacts [ 34 ], missed opportunities [ 37 ], population access to quality care [ 42 ], quality coverage [ 64 ], quality-adjusted contact [ 51 ], quality-adjusted coverage [ 40 ] and treatment pathway [ 56 , 57 ].…”

“…Where multiple interventions were being delivered within a single service such as childbirth, postnatal care and sick child care, studies either reported a combined measure or separate measures for each intervention delivered ( Table 3 and Table 4 ). For example, four studies of sick child care reported a single measure for a package of interventions for the management of childhood illness, including diagnosis and treatment of malaria, treatment of diarrhoea with oral rehydration solution and treatment of respiratory infections [ 33 , 38 , 39 , 50 , 55 ]. Conversely, two studies on sick child care presented a separate measure for each intervention examined [ 43 , 54 ].…”

“…Only 23 studies reported the approach taken, which varied across service or intervention type. International recommendations were most frequently cited as guiding item selection in studies of childbirth and sick child care [ 32 - 35 , 39 , 48 , 50 , 51 , 53 , 54 , 56 , 57 , 62 ], while national guidelines were reported to inform timing and completeness of vaccinations [ 37 , 63 , 64 ]. Differences in national priorities account for some of the variation in the items selected, for example two studies, one in Kenya and the other in Ghana, included different packages of vaccines based on the respective national guidelines [ 41 , 64 ].…”

Factors influencing quality nutrition service provision at antenatal care contacts: Findings from a public health facility-based observational study in 21 districts of Bangladesh

“…Another challenge is ensuring the quality of nutrition interventions provided at ANC contacts, without which programmes will not fully harness the benefits of these interventions on maternal and child nutrition outcomes. Moreover, a recent study reported incomplete readiness of healthcare facilities to provide nutrition interventions during ANC (51%) [ 12 ]. Nutrition input-adjusted coverage was suboptimal (18% for ANC) and disproportionately affected the poor and women with lower educational attainment.…”