Current practices and challenges in assessment of nutritional status among hospitalized children at Moi Teaching and Referral Hospital, Eldoret Kenya

Abstract

Background: Malnutrition occurs due to deficiencies, excesses or imbalance in essential nutrients. Anthropometry is objective and forms the basis for diagnosis and classification. Various nutritional classification methods have been adopted; however, the World Health Organization (WHO) recommends the use of weight for height and Mid Upper Arm Circumference (MUAC) because of their objectivity. Previous studies have reported infrequent nutritional status assessment and classification. This could lead to missed cases, delayed intervention and negative impact on patient outcomes. Objectives: To describe the nutritional assessment practices and barriers to assessment of nutritional status among children aged 6-59 months seen at Moi Teaching and Referral Hospital (MTRH). Methods: This study adopted a cross-sectional mixed method sequential design among children hospitalized at MTRH pediatric medical wards between January to June 2017. A total of 322 children aged 6-59 months were sampled systematically from the pediatric wards while a stratified sampling technique was used to recruit the healthcare workers in the pediatric wards. Anthropometric measurements were taken from all the sampled children and their clinical charts reviewed. Key-informant interviews were conducted among sampled nurses and nutritionists, followed by three focus group discussion sessions with the clinicians to evaluate reasons behind the current nutritional assessment practices. Quantitative data was analyzed to determine the proportion of children correctly classified, anthropometric measurements taken and their associated factors using descriptive (median, frequencies and proportions) and inferential (Pearson chi-square test) statistical techniques at 95% confidence interval. Qualitative data was transcribed and analyzed thematically on N-Vivo version 12 software. Results: Majority of the children 184 (57.1 %) were male, 191 (59.3%) were aged between 6-24 months with 293 (91%) of them being admitted for the first time. Weight was taken among all the children sampled while height (17.1%) and MUAC (15.5%) were infrequently measured. Wasting and edema were significantly associated with MUAC and height measurements (p-value <0.001). The most common form of malnutrition was severe acute malnutrition 68 (21.2%). Healthcare workers classified the nutritional status of 67 (20.8%) children of whom 55 (82.1%) were correctly classified based on WHZ scores. The reasons for lack of nutritional assessment and classification of all admitted children given by healthcare workers included: insufficient equipment, high number of patients and inadequate in-service training. Conclusions: All children had their weight taken while height and MUAC were not routinely done. Nutritional status was rarely classified however most of those classified had it appropriately done. Low levels of nutritional status assessment were attributed to inadequate equipment, high number of children and inadequate training of staff. Recommendations: Routine nutritional assessment and classification should be done for all children admitted at MTRH. There is need to provide adequate nutritional assessment equipment and training of staff.