Assessment of Barriers that delay for Acute Malnutrition Treatment among under-five children in Lay Gaynet, Amhara, Northwest Ethiopia: 2020. A Qualitative Content Analysis Study.
Authors: Meshesha Habtemariam Abate , Birhane Adugnaw , Tamire Mulugeta , Diress Molla Gashu , Worku Walelign 
Published: February 2021

Abstract
Background: about 55 million children under the age of five suffer from acute malnutrition; 19 million of these suffer from the most serious type of severe acute malnutrition. Every year, 3.1 million children die of malnutrition. However; evidence in the study area is rare. Thus, exploring barriers that delay acute malnutrition care of under-5 children qualitatively to have for detailed understanding and evidence-based interventions in a holistic approach is vital.Objectives: The objective aimed to explore the barriers that delay acute malnutrition treatment services among parents/caregivers having under-five children from June 01/2020 to August 28/2020.Methods: A descriptive qualitative content analysis study with a purposive sampling technique were employed to conduct in-depth interview among parents/caregivers, and key informant interview among health workers, health administrators and community health development army leader. The data was collected by two trained research assistants, 6 parents/caregivers for in-depth interviews, and 16 participants for the key informant interview with observations of the practice. Open code version 4.02 software was used for data management during analysis. Coding and codebook were prepared. There were simultaneous data collection and initial analysis to grasp what was said and how it was said by memoing, verbatim transcription was undertaken. All of the audio-records were transcribed verbatim and translated from Amharic into English by an experienced translator for analysis. We provided both the transcriber and translator with a brief description of the research scope and objectives of the data to enhance their understanding of the subject matter. The transcripts and translations were cross-checked for consistency. A qualitative content analysis method was hired to conduct the analysis process. Result: Parents faced lack of health-seeking behaviours: lack of awareness, perceptions of illness behaviours, poverty, workload, and traditional beliefs; poor infrastructures and difficult geographical setup, the travel distance, inaccessibility of the service, and lack of organized treatment facility, COVID-19 pandemic, lack of sustainable interventions, lack of skilled and committed health worker, lack of health worker training, discontinuity of stock supply and long waiting time to receive the treatment were identified as the barrier for early prevention and treatment of under-5 child acute malnutrition. Conclusion: The health education and promotion on social behavior change communication (SBCC) had to be strengthened, and monitored along with health workers' skill development and successive training. There should be strong and close monitoring and evaluation of the impacts of the service provision and inter-sectoral collaborations among different sectors. It also needs to evaluate the impacts of projects in the area on SBCC for AMTS.