**Background:** Malnutrition during childhood leads to impaired growth, delayed social and cognitive development, and reduced productivity later in life. Globally, undernutrition is associated with 45% of child deaths, most occurring in low- and middle-income countries. In Egypt, 22% of children under 5 years are stunted, 9.5% are underweight, and 11% of infants are born with low birth weight. Educating caregivers has been shown to improve child health outcomes, yet health care providers (HCPs) in developing countries often lack adequate training in child malnutrition management. This study aimed to explore barriers to providing adequate nutrition care services in a child malnutrition clinic in a low-resource setting.
**Methods:** An exploratory cross-sectional study using a qualitative approach was conducted at the Center of Social and Preventive Medicine (CSPM) Malnutrition Clinic, Faculty of Medicine, Cairo University, Egypt. Participants were selected via purposive sampling. Five out of seven HCPs in the clinic participated (two male physicians, one female physician, and two female nurses). The interviewed physicians graduated between 1995 and 2001; nurses graduated in 1985 and 1990. The median working years was 6 years (range 8–20 years). Qualitative data were collected through in-depth, audiotaped face-to-face interviews (up to 45 minutes each) using a semi-structured interview guide. Quantitative data were collected by scoring the patient education materials (PEMs) available in the clinic using the Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P), which generates separate understandability and actionability percentage scores. Thematic content analysis was used for qualitative data.
**Key Results:** The most frequent malnutrition problems encountered were rickets, parasitism, underweight, kwashiorkor, and failure to thrive. Three categories of barriers were identified: (1) Physician-centered barriers: limited nutrition education in medical school and postgraduate studies; physicians reported feeling "ill-qualified to provide nutrition advice in the clinical setting." (2) Health system-centered barriers: inadequate capacity building (infrequent training—no nutrition care training in the past year), insufficient time per patient (20–25 minutes for approximately 40 patients daily), shortage of workforce (no new recruitment of residents and nurses, low salary of 1200 LE per month), lack of incentives, shortage of nutritional supplements (iron, zinc, folic acid, vitamin A), lack of updated standard of practice (SOP) and guidelines, and suboptimal PEMs. The PEM had an understandability score of 54% and an actionability score of 40%, both far below the recommended minimum of 70%. (3) Caregiver-centered barriers: low socioeconomic status with limited access to healthy food, limited nutrition knowledge, and false cultural beliefs (e.g., belief that breastfeeding after getting pregnant could cause kwashiorkor in the breastfed child). HCPs suggested improvements including continuing medical education, counseling skills training, and development of context-appropriate guidelines.
**Clinical Implications:** The study highlights that most barriers to adequate nutrition care for child malnutrition in low-resource settings are health system-related, including insufficient resources (workforce shortage, lack of nutritional supplements and PEMs) and inadequate management of resources (lack of skill-based training, updated SOP/guidelines, and properly designed PEMs). Addressing these barriers requires multifaceted approaches: integrating clinical nutrition into medical and nursing curricula, establishing pediatric clinical nutrition fellowship programs, increasing production and availability of nutritional supplements, and developing adequately tested PEMs that suit the sociodemographic characteristics of served communities. The findings are particularly relevant for Egypt and other low- and middle-income countries where childhood malnutrition remains a significant public health challenge.