Structured Play Integration into Nutritional Rehabilitation for Acute Malnutrition in Uganda: An Assessment from Ugandan Referral Hospitals

Abstract

Background: Play and stimulation are essential in treatment of acute malnutrition. However, the extent to which they are implemented in Uganda is unknown. We assessed the status of structured play integration into management of acute malnutrition in three referral hospitals, as well as facilitators and barriers to this integration in Uganda. Methods: This cross-sectional study took place between November and December 2023, using both qualitative and quantitative methods. We conducted 11 Focus Group Discussions (FGDs) with 86 caregivers of children under five years with acute malnutrition, and 25 Key Informant Interviews (KIIs) with various stakeholders. Quantitative data was obtained electronically using a Health Facility Assessment tool adapted from the National Nutrition Service Quality Assessment (NSQA) tool. Each section of the tool has scores, and the total score obtained was changed into a percentage. The study involved three conveniently sampled referral hospitals; Mulago National Referral Hospital (NRH), Mbarara and Moroto Regional Referral Hospitals (RRHs). Results: The scores of integration of structured play into nutrition services were 62% of the expected scores at Moroto RRH, while Mulago and Mbarara hospitals scored 32% and 36%, respectively. Facilitators of integration included funding, a supportive policy environment, training of health workers, and supportive infrastructure at the health facilities among others. The main barriers to integration were funding gaps, lack of data, human resource gaps and lack of policies. Data gaps included lack of research evidence and lack of play indicators in the data capture tools to monitor play. Policy barriers included lack of clarity on implementation of play, planning, coordination and finances. The absence of a designated cadre to lead play coupled with over-worked health workers also hinders structured play integration. Conclusion: Structured play integration into nutritional rehabilitation is very low, calling for urgent need to address the policy, data, health facility infrastructure and human resource gaps identified. Keywords: structured play, acute malnutrition, early childhood development