caretakers in order to promote good nutrition of the
children (Table 4) and the information given was found to
be the same recommended by the IMAM guidelines
2010, although some of the information was not widely
known by the respondents especially the importance of
breast feeding 26 (52%), yet the IMAM guidelines takes
breast feeding to be important in the prevention of SAM.
This is attributed to lack of the IMAM guidelines at the
health facilities for the health workers to keep reminding
themselves of the key points in the management of
malnutrition.
Practice of health workers
All the health centers visited had weighing scales;
however, a significant number 56 (24.9%) of children
were not weighed contrary to the recommendations of the
WHO (1999) guidelines that recommends to weigh all the
children that come to the health centre for growth
monitoring. In addition, weight is important in determining
low weight for age and wasting (Antwi, 2011), hence this
contributes to missed diagnosis in the identification of
PEM and it may be due to too much worker load,
because the same health workers care for children and
adults (Table 5).
Most 3 (60%) of the health centers had MUAC tapes.
Those centers that did not have them cannot measure
the mid upper arm circumference of the children which is
an important parameter in the diagnosis of PEM leading
to missed diagnosis. Furthermore, even those centers
that had the MUAC tapes were not using them as
evidenced by the low numbers 32 (14.2%) of children
whose MUAC was measured (Table 5). This poor
practice contributes to missed diagnosis of PEM, hence
missed opportunity to prevent mild-moderate PEM from
progressing to SAM. This probably may be due to lack of
knowledge on how to use the MUAC tapes, heavy work
load or not knowing how to diagnose malnutrition using
MUAC.
Of the health centers visited, 3(60%) had height boards
which means that the health centre that did not have
them could not measure height of the children, yet
measurement of height is an important parameter in the
diagnosis of underweight and stunted growth (WHO,
1999). However, even those centers that had the boards
were not measuring the height since just 32 (14.2%) of
the children had their height measured. It is most likely
that the health workers think it is not important to
measure height of the children or they are too busy to do
it (Table 5).
The study revealed that all the five health centers
visited did not have the IMAM Guidelines (2010). In
addition to that, all the health workers interviewed had
never seen the guidelines. This explains the knowledge
gaps in the diagnosis and management of PEM since
they do not have any references. These guidelines were
adapted and published in 2010 to address issues of