The prevalence of malnutrition in hospitalized adult patients at the Aga Khan University Hospital in Nairobi, Kenya

Wanja, Munyi Faith (2018-03)

Thesis (MNutr)--Stellenbosch University, 2018.

Thesis

ENGLISH SUMMARY : Rationale: The prevalence of adult malnutrition upon hospital admission varies between 10-60%. Knowing the extent of the problem and identifying at-risk patients should be a priority task as the consequences of malnutrition has been shown to negatively impact the working of every organ in the human body system and delayed recuperation from illness. There are a limited number of studies conducted on malnutrition in hospitalized patients in Africa and in Kenya: hence, the aim of this study was to determine the prevalence of malnutrition risk in hospitalized adult patients at the Aga Khan University Hospital in Nairobi, Kenya. Methods: This was part of a multi-country, multicentre, descriptive cross-sectional study with an analytical component. Adult patients (n=413) were screened (NRS-2002) upon admission and at discharge (if length of hospital stay was more than seven days), and relevant outcomes on the prevalence of malnutrition were charted. Nutritionally at-risk patients were indicated if the NRS-2002 score was ≥3. Summary statistics, appropriate analysis of variance (ANOVA) and non-parametric methods were used. The statistical significance was set at 95%. Results: 413 hospitalized adult patients (42.4 ± 13.84 years old; 51% female) were screened on admission. 64% of these patients were admitted in the medical ward, followed by 34% in the surgical ward. The mean BMI was 27.07 ± 5.43 kg/m2 upon admission. Out of the study population, 45.5% (n=188) of these patients were at risk of malnutrition. The mean length of the hospitalization of these patients were 4.4 days (±5.99 SD). Upon discharge, n=48 were assessed. It was found that nutritionally at-risk patients upon discharge were 61%. Despite the high prevalence of malnutrition, only 4% of the total population (n=18) were referred for nutritional therapy upon admission. Only 6.4% (n=12) of nutritionally at-risk patients were referred for nutritionl support. Conclusions:With 45% of all patients being nutritionally at risk upon admission to the hospital, there is a need, now more than ever, to reinforce nutritional screening and timely referral. With this data, more studies on the prevalence of adult hospital malnutrition need to be conducted in Kenya and other developing countries, applying the same screening tools. This will allow for comparisons of the prevalence of hospital malnutrition, outcomes and validity. Less strict exclusion criteria needs to be applied to obtain a more accurate reflection of the true prevalence of at-risk and malnourished patients.

AFRIKAANSE OPSOMMING : Rationaal: Die prevalensie van volwasse wanvoeding met hospitaal toelating wissel tussen 10-60%. ‘n Kennis van die omvang van die probleem en identifikasie van pasiënte met ‘n risiko tot wanvoeding behoort ‘n prioriteit te wees, aangesien die gevolge van wanvoeding ‘n negatiewe impak het op elke orgaan in die liggaam en herstel vertraag. Daar is ‘n beperkte aantal studies gedoen rakende wanvoeding in gehospitaliseerde pasiënte in Afrika en Kenia. Gevolglik was die doel van die studie om die prevalensie van die risiko vir wanvoeding in gehospitaliseerde volwasse pasiënte in Aga Khan Universiteit Hospitaal in Nairobi, Kenia te bepaal. Metodes: Hierdie dwarssnit beskrywende studie met ‘n analitiese komponent, was deel van ‘n multi-sentrum studie in verskeie lande. Volwasse pasiënte (n=413) het ‘n siftingstoets (NRS-2002) ondergaan met toelating en ontslag (indien lengte van hospitalisasie meer as sewe dae was) en relevante uitkomste rakende die prevalensie van wanvoeding is aangeteken. ‘n NRS-2002 telling van ≥3 het ‘n risiko vir wanvoeding aangetoon. Beskrywende statistiek, gepaste analise van variansie (ANOVA) en nie-parametriese metodes is gebruik. Statistiese beduidenheid is gestel op 95%. Resulate: 413 Gehospitaliseerde volwasse pasiënte (42.4 ± 13.84 jaar oud; 51% vroulik) het toelating sifting ondergaan. Die meerderheid (64%) is toegelaat tot die mediese saal, gevolg deur 34% in die chirurgiese saal. Die gemiddelde liggaamsmasse indeks was 27.07 ± 5.43 kg/m2 met toelating. ‘n Totaal van 45.5% (n=188) pasiënte het ‘n risiko tot wanvoeding getoon met toelating. Die gemiddelde lengte van hospitalisasie was 4.4 (± 5.99 SD) dae. Met ontslag is 48 pasiënte evalueer, waarvan 61% ‘n risiko tot wanvoeding getoon het. Ondanks die hoë prevalensie van wanvoeding is slegs 4% (n=18) van die totale populasie verwys vir voedingondersteuning met toelating. Slegs 6.4% (n=12) van diegene met ‘n risiko tot wanvoeding was verwys vir voedingondersteuning. Gevolgtrekking: Met 45% van alle pasiënte wat ‘n risiko tot wanvoeding getoon het met toelating tot die hospitaal is die behoefte nou, meer as ooit, om voedingsifting en tydige verwysing te beklemtoon. Meer studies om die prevalensie van volwasse hospitaal wanvoeding te bepaal is nodig in Kenia en ander ontwikkelende lande, deur gebruik te maak van dieselfde siftingshulpmiddels. Dit sal vergelykings van die prevalensie van hospitaal wanvoeding, uitkomste en geldigheid moontlik maak. Minder streng uitsluitingskriteria moet toegepas word om ‘n meer akkurate refleksie te kry van die werklike prevalensie van pasiënte met ‘n risiko tot wanvoeding.

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