Experiences of health professionals with nutritional support of critically ill patients in tertiary hospitals in Malawi|
Bunyani, A.; Mtimuni, B.; Kalimbira, A. & Kamalo, P.
Nutritional support is a recognized determinant of outcome in critically
ill patients. Development of critical care services in low-income countries
has not been accompanied by certain appropriate ancillary services
and interventions, such as adequate nutritional support. This study was
designed to investigate the experiences of health professionals who have
provided nutritional supportive care to critically ill patients admitted to
two major central hospitals in Malawi, with the aim of identifying the
common practices in nutritional support in these settings.
Materials and Methods
A cross-sectional study in which 50 health professionals working in
intensive care and high dependency units, admitting both adult and
pediatric patients, were interviewed using a semi-structured questionnaire.
Data were coded and then analyzed using SPSS version 16.0. Responses
between the two hospitals were compared using Fisher’s exact test.
There was no difference in the composition of respondents from the two
hospitals. About 60% of respondents had had experience with nutritional
supplementation in their patients—mainly enteral. The most commonly
used formulations were the “ready-to-use therapeutic feeds,” followed
by modified milk. A high percentage of respondents (40%) reported
having used dextrose solution as the sole nutritional supplement. Lack of
in-service training, nonexistent nutrition protocols pertaining to acutely
and critically ill patients, and a lack of clinical nutritionists were the major
Knowledge of nutrient supplementation was poor among the respondents.
The use of ready-to-use therapeutic feeds was quite common, although
there is no evidence of its effectiveness in care of acutely critically ill
patients. There is a need to establish nutritional support teams in these
tertiary hospitals. Clinical nutritionists would ideally help train and play
leadership roles in such teams, who would be responsible for assessing
patients for their nutritional needs, and ensuring that the feeds provided
to patients are appropriate and adequate for their needs.