Healthcare workers' knowledge, and practices, and associated factors in managing uncomplicated severe acute malnutrition in the Northwestern zone, Tigray, Ethiopia, 2025.

Abstract

Introduction: Suboptimal healthcare workers’ knowledge and practices in severe acute malnutrition management contribute to preventable complications and deaths in children. Data on healthcare workers’ knowledge and practices regarding uncomplicated severe acute malnutrition (SAM) management in primary healthcare facilities within Ethiopia’s Tigray region are limited. Objective: To assess healthcare workers' knowledge and practices, and related factors in managing uncomplicated severe acute malnutrition in the Northwestern Zone of Tigray, Ethiopia, 2025. Method: A concurrent parallel mixed-methods study was conducted from March to May 2025, involving 385 healthcare workers from the selected health facilities for the quantitative component and purposively sampled participants for qualitative data. Data were collected using pretested structured questionnaires, observation checklists, and an interview guide. A multivariate logistic regression model was employed to identify factors associated with knowledge and practices based on adjusted ORs with 95% CIs and p-values less than 0.05. Thematic analysis was used for the qualitative data. Result: Only 68.05% of healthcare workers had adequate knowledge, and a mere 44.42% exhibited good practices in managing uncomplicated severe acute malnutrition. The factors positively associated with healthcare workers’ knowledge and practices included male sex (AOR=1.82, 95% CI: 1.19-2.8), 11-15 years of work experience (AOR=2.59, 95% CI: 1.09-6.18), and receiving refresher training (AOR=7.88, 95% CI: 3.89-15.97). Conversely, being a diploma nurse (AOR=0.32, 95% CI: 0.16-0.66) and the unavailability of guidelines (AOR=0.58, 95% CI: 0.38-0.87) were negatively associated. The qualitative findings further highlighted resource and infrastructure deficiencies and high workload as barriers to effective uncomplicated severe acute malnutrition management. Conclusion and recommendation: Healthcare workers’ knowledge and practices regarding uncomplicated SAM management in the Northwestern Zone of Tigray are suboptimal. Targeted interventions, including providing regular refresher training, enhancing supervision, and improving access to guidelines and essential resources, are crucial to improve the knowledge and skills of healthcare workers in managing uncomplicated SAM. Further longitudinal research is also recommended.