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Nutrition in acute and chronic diseases

High prevalence, low identification and screening tools of hospital malnutrition in critically- ill patients in Malawi

European Journal of Clinical Nutrition volume 76, pages 1158–1164 (2022)Cite this article

Subjects

Abstract

Background/objectives

In Africa, approximately two-thirds of patients are at risk of malnutrition on admission and the nutritional status of patients deteriorates during hospitalization, with associated increased morbidity, mortality, and hospital-related cost. This cross-sectional study aimed at estimating rates of malnutrition in critical care units and determining the extent to which malnutrition diagnoses are documented in medical records by physicians, at two public tertiary hospitals in Malawi.

Methods

A total of 315 adult (n = 112) and paediatric (n = 203) participants from Queen Elizabeth Central Hospital and Kamuzu Central Hospital, were included in the analysis. Nutrition status was measured by Subjective Global Assessment (SGA) and Mid-Upper Arm circumference (MUAC) and medical notes were reviewed, in both adults and paediatrics.

Results

In adults, more than half were malnourished, with a higher proportion considered moderately-to-severely malnourished using SGA compared to MUAC (84.8%; 57.3%, respectively). Likewise, in paediatrics, a higher proportion was considered moderately-to-severely malnourished using SGA compared to MUAC (84.7%; 23.4%, respectively). Both adult and paediatric patients with cancer had the highest rates of malnutrition. Only 12.9% and 9.6% had documentation of malnutrition diagnosis in the medical record, for paediatrics and adult patients, respectively.

Conclusion

The high rates of hospital malnutrition in critically ill patients in Malawi call for comprehensive screening practices and methods; complemented by documentation of the malnutrition diagnosis and use of nutrition interventions by dietitians. This includes enteral, parenteral and supplemental nutrition as a prerequisite for patient recovery in hospitals.

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Fig. 1: Documented malnutrition by SGA per diagnostic category.
Fig. 2: Comparison of MUAC and SGA to diagnose moderate and severe malnutrition.
Fig. 3: Relationship between MUAC and SGA by age.

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Acknowledgements

We would like to thank Ulemu Luwinga, Oswin Kamangira, Chipi Dannayo, Limbikira Wasambo, Takondwa Limbe, and Joseph Mulekano, for their assistance with screening of hospitalized patients.

Funding

This research was funded by the 2019 Wimpfheimer-Guggenheim Fund for International Exchange in Nutrition, Dietetics, and Management Award; Academy of Nutrition and Dietetics.

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Authors and Affiliations

  1. Frontier Innovators Global, Lilongwe, Malawi

    Bernadette Chimera-Khombe

  2. Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, CA, 93407, USA

    Grace Barcus & Peggy Papathakis

  3. Department of Statistics, California Polytechnic State University, San Luis Obispo, CA, 93407, USA

    Andrew Schaffner

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  1. Bernadette Chimera-Khombe
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Contributions

BC- Conceived and designed the study, performed study, wrote paper; GB- Analysed data and wrote paper; AS-Analysed data and wrote paper; PP- Designed and performed study and wrote paper.

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Correspondence to Bernadette Chimera-Khombe.

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Chimera-Khombe, B., Barcus, G., Schaffner, A. et al. High prevalence, low identification and screening tools of hospital malnutrition in critically- ill patients in Malawi. Eur J Clin Nutr 76, 1158–1164 (2022). https://doi.org/10.1038/s41430-022-01087-5

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