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. 2024 Feb 22;23(1):35.
doi: 10.1186/s12939-024-02129-z.

Low quality of maternal and child nutritional care at the primary care in Mexico: an urgent call to action for policymakers and stakeholders

Omar Acosta Ruiz  1 , Monica Ancira-Moreno  2   3 , Isabel Omaña-Guzmán  4   5 , Sonia Hernández Cordero  6 , Arturo Cuauhtémoc Bautista Morales  1 , Cecilia Pérez Navarro  7 , Soraya Burrola Méndez  7   4 , Eric Monterrubio Flores  8 , Alejandra Trejo  7 , Martha Kaufer-Horwitz  9 , Ariana Cajero  7 , Belén Sánchez  7 , Constanza Bernat  7 , Elder Salgado-Amador  4 , Elizabeth Hoyos-Loya  4 , Mónica Mazariegos  10 , Cinthya Muñoz Manrique  11 , Royer Pacheco Cruz  7   12 , Elvia Mendoza  7 , Mauro Brero  13 , Matthias Sachse  13 , Fernanda Cobo Armijo  13
Affiliations

Low quality of maternal and child nutritional care at the primary care in Mexico: an urgent call to action for policymakers and stakeholders

Omar Acosta Ruiz et al. Int J Equity Health. .

Abstract
in English, Spanish

Background: Maternal and child malnutrition represents a public health problem in Mexico Primary care (PC) is responsible for introducing women and children under five to the health system, detecting diseases on time, and providing medical services, including pharmacological treatment if necessary. Providing these services with quality is essential to improve maternal and child health. This study evaluated the quality of nutritional care during preconception, pregnancy, postpartum, infancy, and preschool age at the PC health units across six Mexican states between 2020 and 2021.

Methods: We conducted a cross-sectional study with a mixed approach in units of the Secretary of Health to assess the quality of nutritional care during preconception, pregnancy, postpartum, childhood, and preschool age. The level of quality was calculated by the percentage of compliance with 16 indicators that integrated a Quality Index of Maternal and Child Nutritional Care (ICANMI, by its Spanish acronym). Compliance by indicator, by life stage, and overall was categorized using the following cut-off points: poor quality (≤ 70%), insufficient quality (71-89%), and good quality (≥ 90%). The perceptions of the barriers and facilitators that affect maternal and child nutrition were evaluated through semi-structured interviews with health professionals (HP) and users. All qualitative instruments were developed with a gender and intercultural perspective.

Results: Considering the whole sample studied, maternal and child nutritional care quality during the five life stages evaluated was bad (compliance: ≤12%), reflected in the ICANMI, which had a compliance of 8.3%. Principal barriers identified to providing high-quality nutritional care were the lack of knowledge and training of health professionals, shortages of equipment, medicine, personnel, and materials, the disappearance of the social cash transfer program Prospera, the absence of local indigenous language translators to support communication between doctor and patient, and the persistence of machismo and other practices of control over women.

Conclusions: These findings underscore the need for initiatives to improve the quality of nutritional care in PC facilities across Chihuahua, State of Mexico, Veracruz, Oaxaca, Chiapas, and Yucatan. It is necessary for government and health authorities, along with various stakeholders, to collaboratively devise, implement, and assess intercultural and gender-oriented policies and programs geared towards ensuring the health infrastructure and enhancing the training of health professionals to diagnose and treat the prevalence and occurrence of diverse forms of malnutrition in both maternal and child populations.

Resumen: ANTECEDENTES: La mala nutrición materno-infantil (MMI) representa un problema de salud pública en México. El primer nivel tiene la respondabilidad de introducir a mujeres y niños menores de 5 años al sistema de salud, detectar oportunamente las enfermedades y brindar servicios médicos incluido el farmacológico de ser necesario. Prestar estos servicios con calidad resulta elemental para mejorar la salud de la población materno-infantil. El objetivo de este estudio fue evaluar la calidad de la atención nutricional durante las etapas de preconcepción, embarazo, posparto, infancia y edad preescolar en centros de salud de seis estados de México entre 2020 y 2021. MéTODOS: Se realizó un estudio transversal con metodología mixta en 95 centros de salud la Secretaría de Salud de México para evaluar la calidad de la atención nutricional durante la preconcepción, el embarazo, el posparto, la infancia y la etapa preescolar. El nivel de calidad se calculó mediante el porcentaje de cumplimiento de 16 indicadores que a su vez integraron un Índice de Calidad de la Atención Nutricional Materno Infantil (ICANMI). El cumplimiento por indicador, etapa de vida y global fue categorizado utilizando los siguientes puntos de corte: mala calidad (≤ 70%), calidad insuficiente (71-89%) y buena calidad (≥ 90%). La percepción sobre las barreras y facilitadores que afectan la atención nutricional materno-infantil fueron identificadas a través de entrevistas semiestructuradas y grupos focales realizadas a profesionales de salud, usuarias y usuarios. Todos los instrumentos cualitativos fueron desarrollados con un enfoque de género e interculturalidad.

Resultados: La calidad de la atención nutricional materno infantil durante las cinco etapas de la vida evaluadas fue mala (cumplimiento: ≤12%), mientras que el ICANMI tuvo un cumplimiento de 8.3%. Las principales barreras identificadas para brindar una atención nutricional de alta calidad fueron la falta de conocimiento y capacitación de los profesionales de la salud, la escasez de equipos, medicamentos, personal y materiales, la desaparición del programa social de transferencias monetarias Prospera, la ausencia de una lengua indígena local, entre otros. Así como la persistencia de prácticas como el machismo y otras de control sobre las mujeres.

Conclusiones: Estos hallazgos subrayan la necesidad inmediata de implementar iniciativas que mejoren el estándar de atención nutricional en los centros de salud en Chihuahua, Estado de México, Veracruz, Oaxaca, Chiapas y Yucatán. Es necesario que el gobierno y las autoridades sanitarias, junto con diversas partes interesadas, diseñen, implementen y evalúen en colaboración políticas y programas orientados a mejorar la calidad de la atención nutricional, con perspectiva de género e interculturalidad. Este esfuerzo tiene como objetivo mitigar la prevalencia y aparición de diversas formas de desnutrición tanto en la población materna como infantil.

Keywords: Child nutrition; Maternal nutrition; Mexico; Nutritional care; Primary health care; Quality care; Quality care indicators.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Quality of nutritional care by indicator, health unit and state. Mexico, 2020–2021. 1- Weight control strategies; 1- Folic acid supplementation; 3- Supplementation pregnancy; 4- Anemia screening; 5- Adequate follow-up; 6- Nutritional evaluation and vitamin supplementation in adolescent pregnancy; 7- Guidance on techniques for effective latching, breast massage and milk expression; 8- Guidance on postpartum weight control; 9- Promotion of exclusive breastfeeding, continued breastfeeding and complementary feeding; 10 - Assessment of nutritional status; 11 - Recommendation to reduce energy intake and fast food in infants with obesity; 12- Follow-up of patients with undernutrition; 13- Timely detection and identification of risk factors for iron deficiency anemia in patients under two years of age with undernutrition; 14- Physical activity and nutritional recommendations; 15- Preschool age children with anthropometric assessment; 16- Recommendations to reduce energy intake and fast food in preschool age children with obesity
Fig. 2
Fig. 2
Quality of nutritional care during preconception, pregnancy, early childhood, and preschool age. Mexico, 2020–2021. ICANMI: Quality Index of Maternal and Child Nutritional Care
See this image and copyright information in PMC

References

    1. WHO Regional Office for South-East Asia. The double burden of malnutrition: Priority actions of ending childhood obesity [Internet]. Vol. 7, Syria Studies. 2015. 37–72 p. Available from: https://www.researchgate.net/publication/269107473_What_is_governance/li... https://think-asia.org/handle/11540/8282%0Ahttps://www.jstor.org/stable/....
    1. WHO. Maternal mortality [Internet]. 2023 [cited 2023 Sep 17]. Available from: https://www.who.int/news-room/fact-sheets/detail/maternal-mortality.
    1. Cuevas-Nasu L, Muñoz-Espinosa A, Shamah-Levy T, García-Feregrino R, Gómez-Acosta LM, Ávila-Arcos MA et al. Estado de nutrición de niñas y niños menores de cinco años en México. Ensanut 2022. Salud Publica Mex [Internet]. 2023 Jun 13 [cited 2023 Sep 17];65:s211–7. Available from: https://www.saludpublica.mx/index.php/spm/article/view/14799. - PubMed
    1. Ancira-Moreno M, Monterrubio-Flores E, Hernández-Cordero S, Omaña-Guzmán I, Soloaga I, Torres F et al. Incidence of low birth weight in Mexico: A descriptive retrospective study from 2008–2017. PLoS One [Internet]. 2021 Sep 1 [cited 2023 Sep 10];16(9):e0256518. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0256518. - PMC - PubMed
    1. Shamah LT, Cuevas NL, Romero MM, Gaona PEB, Gómez ALM, Mendoza AL et al. Encuesta Nacional de Salud y Nutrición 2018-19. Resultados Nacionales [Internet]. Instituto Nacional de Salud Pública. 2020. 268 p. Available from: https://ensanut.insp.mx/encuestas/ensanut2018/informes.php.