Nutritional risk and associated factors of adult in-patients at a teaching hospital in the Copperbelt province in Zambia; a hospital-based cross-sectional study

Abstract

Background: Nutritional risk and undernutrition are common problems among medical and surgical patients. In hospital, malnutrition is frequently under-diagnosed and untreated thereby contributing to morbidity and mortality. The purpose of this study was to determine the prevalence of nutritional risk among adult inpatients at a teaching hospital in Zambia. In addition, the study sought to establish factors associated with nutritional risk. Methods: A hospital-based cross-sectional study comprising of 186 consecutive in-patients aged 18-64 years admitted in medical and surgical wards was conducted at a teaching hospital. Out of one hundred and ninety eight (198) patients eligible to participate, complete data were collected from 186, representing a response rate of 93.9%. The Malnutrition Universal Screening Tool was used to collect data over a period of six months. Evaluated patients were dichotomized into no risk and nutritional risk. Binary logistic regression was performed to identify variables associated with nutritional risk. Results: The mean age of adult in-patients was 40.72 ± 14.4 years. Majority of the patients were male (61.8%), while 38.2% were female. Results indicate that 59.7% of hospitalized patients were at nutritional risk. Vomiting, weakness, appetite decrease, dysphagia and weight loss were significantly associated (p = 0.019, p = 0.008, p < 0.001, p = 0.007, and p < 0.001 respectively) with nutritional risk. However, weight loss and appetite decrease were the most significant factors associated with nutritional risk (OR = 50.16, 95% CI = 5.75-36.70, p < 0.001 and OR = 28.06, 95% CI =1.49-8.12, p = < 0.001 respectively).Conclusion: Findings of our study suggest that close to 60% of adult inpatients at the teaching hospital were at nutritional risk. Nutritional risk is an issue of major concern at the teaching hospital and is associated with a number of variables. Identification of nutritional risk using Malnutrition Universal Screening Tool among adult inpatients is feasible in resource-poor settings like ours.

The Problem of Hospital Malnutrition in the African Continent

“…Although a wide age-range was included, the median age of the patients (43 years) was at least a decade younger than those reported for similar studies done in Europe, ranging between 57–72 years [1,2,8,15,20,21]. It is closer to the mean ages of similar studies conducted on the African continent which reported a mean age of 34 years (Burundi) [27], 37 years (Uganda) [3], 41 years (Zambia) [28], 47 years (Cameroon) [29], and 48 years (South Africa) [6], highlighting the differences in patient profiles between continents.…”

“…Using a different tool (MUST), another study from South Africa reported a risk of malnutrition of 72.3% [6]. Data from Zambia [28] reported a 59.7% and Uganda [3] a 25–59% prevalence. Hospital malnutrition (defined as ≥10% weight loss from usual weight) was reported to be 47.3% in Burundi [27] and data from Cameroon (defining malnutrition as BMI < 18.5 kg/m 2 , and/or MUAC < 22 cm for women and 23 cm for men) reported 19.3% [29].…”

Nutrition Screening, Reported Dietary Intake, Hospital Foods, and Malnutrition in Critical Care Patients in Malawi

“…In Africa, 25 to 72.3% of hospitalized patients are at risk for malnutrition [ 1 , 2 , 3 ]. Hospital malnutrition is a concern globally, however there are limited studies on the prevalence of hospital-based malnutrition in low resource countries, like Malawi.…”

Review of enteral nutrition practices in critically ill adults in resource-limited environments

“…Therefore, an alternative method which has been successfully used in low-resource settings since the 1990s is the mid-upper arm circumference (MUAC) 15–17. More recently, MUAC has been successfully used in resource-limited environments as a malnutrition screening tool for both hospitalised and critical care patients 15 18 19. Barcus et al ’s audit of nutritional status of critically ill patients in Malawi used MUAC to determine malnutrition and found 62% of adult critical care patients had moderate to severe malnutrition 14…”

“…[18-20] More recently, MUAC has been successfully used in resource limited environments as a malnutrition screening tool for both hospitalised and critical care patients. [18,21,22] Barcus et al's (2021) audit of nutritional status of critically ill patients in Malawi used MUAC to determine malnutrition and found 62% of adult critical care patients had moderate to severe malnutrition. [11]…”