The Problem of Hospital Malnutrition in the African Continent

Abstract

This study aims to determine the prevalence of risk of malnutrition on admission and discharge in African hospitals, and to identify the association with selected indicators. In this multi-center prospective cohort study, adult patients from hospitals in South Africa, Kenya, and Ghana were screened on admission and discharge and contacted 3 months post-discharge. Relevant morbidity and mortality outcomes were assessed. At risk of malnutrition was indicated if NRS-2002 score ≥3. Adult patients (n = 2126; 43.11 years, IQR: 31.95–55.60; 52.2% female) were screened on admission and 61% were identified as at risk of malnutrition. The proportion of at-risk patients for the three hospitals in Kenya and Ghana (66.2%) were significantly higher than that of the three South African hospitals (53.7%) (Chi2 = 31.0; p < 0.001). Discharge risk of malnutrition was 71.2% (n = 394). Mean length of stay (LOS) was 6.46 ± 5.63 days. During hospitalization, 20.6% lost ≥5% body weight, 18.8% were referred for nutrition support, and discharge BMI (23.87 ± 7.38 kg/m2) was significantly lower than admission BMI (24.3 ± 7.3 kg/m2) (p < 0.001). Admission nutrition risk was associated with lower admission and discharge BMI (p < 0.001), longer LOS (p < 0.001), increased 3-month re-admission rates (Chi2 = 1.35; p = 0.245) and increased mortality (Chi2 = 21.68; p < 0.001). Nearly two-thirds of patients were at risk of malnutrition on admission. This was associated with longer LOS and greater hospital mortality. The nutritional status of patients deteriorated during hospitalization. Routine screening practices with appropriate nutrition support action should be implemented as a matter of urgency.

Risk factors for malnutrition among hospitalized gastroenterological patients

“…Similar results have been published by some other authors, who reported a significant decrease in MAMC, fat-free mass, albumin level, weight and BMI during hospitalization. 7,9,10 In our study there was a decrease in the values of all NSAPs, except lymphocytes.…”

“…[1][2][3] It significantly contributes to the many adverse outcomes, such as cardiovascular and infective complications, increased morbidity and mortality, prolonged hospitalization, increased hospitalization costs and increased re-admission rates after discharge from the hospital. [4][5][6][7][8] Although these consequences of poor nutritional status are well known, malnutrition is often undiagnosed on hospital admission. Furthermore, some patients have deterioration of the nutritional status and become malnourished during hospitalization, regardless of their initial nutritional status, but this change often remains unrecognized by the medical staff.…”

“…Furthermore, some patients have deterioration of the nutritional status and become malnourished during hospitalization, regardless of their initial nutritional status, but this change often remains unrecognized by the medical staff. 7,9,10 If we keep in mind that malnutrition can potentially be prevented and treated, identification and definition of risk factors for malnutrition is of particular interest. Many studies investigated the risk factors for malnutrition among the patients on hospital admission.…”

Nutritional risk and nutritional status in hospitalized older adults living with HIV in Shenzhen, China: a cross-sectional study

“…This study used the NRS-2002 to evaluate nutritional risk in hospitalized older PLWH. Although the NRS-2002 is a widely used tool in PLWH, some HIV-specific variables, such as viral load, are not included in this measurement tool [ 9 , 23 , 24 ]. In particular, HIV or AIDS, which is regarded as a chronic wasting disease, is also not included in first domain of the NRS-2002 [ 25 ].…”

Nutrition Capacity Building to Meet National Priorities: Lessons Learned in Developing and Implementing Malawi's First Dietetics Program

“… 6 , 11 In a small study of 25 patients, the average rate of malnutrition in hospitalized surgical patients in Malawi was 80%, which is double the world average. 12 , 13 …”