Prevalence, Detection and Management of Malnutrition among Medical Wards Adult In-Patients of Rift Valley Provincial General Hospital, Nakuru County, Kenya
Kimani, Lydia Wambui
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Malnutrition in patients has been associated with reduction in function of every part of the body organs. In hospitalized patients malnutrition contributes to high treatment costs, increased length of stay, secondary infections and deaths. Failure to follow nutrition guidelines and poor documentation by dietician, nurses and other healthcare professionals may contribute to malnutrition and related complications. This study assessed prevalence and management of adult malnutrition among in-patients in general medical wards of Rift Valley Provincial General Hospital, Nakuru County. The study employed a cross sectional study design with both quantitative and qualitative techniques targeting adult patients in the general medical wards and health care workers. Primary data was gathered using researcher administered questionnaires, 24 hour dietary recall, observation checklist/guides and Malnutrition Universal Screening Tools (MUST). Patients’ records were used to gather secondary data on implementation of Standard Operating Procedures (SOPs) in nutrition management. Key informant interviews were used to gather qualitative data. Statistical analysis was performed using Statistical Package for Social Science (SPSS version 20). Descriptive statistics were used to describe continuous variables such as age, weight and height. The 24hr dietary recall was analyzed using Nutri-survey software to get nutrient intake. Association between categorical and independent variables (risk factors, nutrient intake and SOPs) and the dependent variable (hospital malnutrition prevalence) were tested using Chi-squire test. All significant differences and associations were tested at p<0.05. Qualitative data was transcribed verbatim and organized into themes. The sample size comprised of 80 patients, proportionately sampled, with 42.5% being male and 57.5% female. A significant proportion of the respondents (55%) were age between 20-49 years. The mean age of the respondents was 47.9 (SD ±19.08) years with the youngest patient aged 19 and oldest 96 years. According to WHO BMI classification, 34 (42.5%) of the respondents were of normal weight 26 (32.5%) were underweight while 20 (25%) were overweight / obese. The prevalence of malnutrition according to MUST classification was 73.8% (High risk 60.0% and moderate risk 13.8%) while 26.25 of the respondents had low risk of malnutrition. The study also observed that age especially for male respondents was significantly associated to the risk of malnutrition (χ2 = 14.190; P = 0.028, p<.05), while food intake (protein χ2 = 0.527, P = 0.726) fat (χ2 = 4.697, p = 0.320) and carbohydrates (χ2 = 1.093, P = 0.895) was not. Diseases such as hypertension and congestive cardiac failure (31.8%), gastro enteritis (16.5%), HIV/AIDS (15%), Pulmonary Tuberculosis (13.8%), diabetes mellitus (13.8%), Peptic Ulcer Disease (17.1%) and Anemia (11.3%) were found to be common among study respondents with high risk of malnutrition in the medical wards. It was also evident that mean energy intake by respondents was much lower (1351.65 kcal/day) compared to the recommended daily allowances (RDA) (1955.18 kcal/day). Finally, study revealed that compliance to the various SOPs concerning the nutrition care process and management in the hospital was generally poor. Consequently, the study recommendations: a multidisciplinary care approach using SOPs for every patient at the point of admission and avail anthropometric tools.