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In low- and middle-income countries, nutrition support strategies are often suboptimal or non-existent in hospital settings. This is further compounded by high rates of malnutrition in these countries. The first four dietitians graduated in Malawi in 2017 providing a new opportunity to build capacity to introduce nutrition support in an acute care setting. A paediatric nutrition support program was implemented at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi including the hiring of a local dietitian. This capacity building paper explains the development and introduction of the nutrition support program including a description of perceptions of health professionals at QECH working alongside the dietitian. In the first four months of the program at QECH, the dietitian provided nutrition support to 183 different patients across paediatric wards. Nutritional interventions predominantly included infant formula and breastmilk fortification, provision of therapeutic feeds orally or via nasogastric tubes, increased dietary protein intake for children identified to be at high risk, and nutritional counselling to caregivers. More complex nutritional interventions were also given such as the insertion of gastrostomy tubes to deliver nutrition directly to the stomach. Following the introduction of the program, qualitative interviews were done with health professionals at QECH including nurses (n = 5) and physicians (n = 11). All participants emphasized the importance and impact of the nutrition support program in enhancing the care of hospitalized children, therefore improving outcomes such as tolerability of clinical interventions, decreased duration of stay, and reduced risk of hospital readmission. In conclusion, there is a need for nutrition support provided by a dietitian for different paediatric patients which was corroborated by positive feedback from health professionals at QECH. Integration of dietitians into the healthcare system by respective Ministries of Health will require advocacy around the potential for nutrition support to strengthen the quality of care of vulnerable children.A Chichewa abstract for this paper is available in a supplementary file.

Objectives The first four dietitians graduated in Malawi in 2017, providing a new opportunity to build capacity to introduce nutrition support in an acute care setting. We designed and implemented a pediatric nutrition support program at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi including the hiring of a local dietitian in August 2018. Upon introducing this program, we aimed to qualitatively assess perceptions around the nutrition support program from the perspective of health professionals at QECH. Methods Qualitative interviews using a narrative research approach were undertaken to understand perceptions about the nutrition support program. Participants were selected through a purposive sampling approach across the eight wards within the nutrition support program at QECH. Interviews were held with nurses (n = 5) and clinicians and surgeons (n = 11) at QECH in November and December 2018. These interviews were audio-recorded before being transcribed and themes were then coded inductively using NVivo 11 software. Results All participants of the qualitative interviews emphasized the importance and impact of the nutrition support program in enhancing care of hospitalized children and therefore improving child outcomes such as tolerability of clinical interventions, decreased duration of stay, and reduced risk of hospital readmission. Other themes that arose were the receptiveness of guardians of children who received nutrition support, the importance of engaging other health professionals in nutrition support, and the need for prioritization of nutrition support by the Ministry of Health to sustain and scale up this type of program in Malawi. Conclusions Qualitative interviews with nurses, clinicians, and surgeons highlighted the value of nutrition support to improve quality of care in low-resource hospital settings. Integration of dietitians into the healthcare system in low- and middle-income countries like Malawi will require further advocacy around the potential for nutrition support to improve outcomes in vulnerable children. Funding Sources The introduction of the nutrition support program was funded by the Centre for Global Child Health Catalyst Grant from the Hospital for Sick Children.