Nutritional assessment practices among health care workers at the paediatric emergency unit at kenyatta national hospital, nairobi county, kenya

Abstract

Assessment of nutritional status in the pediatric population is useful in estimating growth patterns and identifying signs and symptoms associated with malnutrition. However, it has become increasingly apparent that pediatric nutritional assessment is not adequately performed and therefore children with nutritional needs are missed out. The main objective of this study was to determine the health care workers’ practices of nutritional assessment of sick children at the Pediatric Emergency Unit (PEU) at Kenyatta National Hospital. Specifically, the study aimed at establishing the frequency of performance of various nutritional assessment parameters among healthcare workers, determining the challenges associated with nutritional assessment at the Pediatric Emergency and determining the health care workers’ knowledge and perceptions on nutritional assessment. This was a descriptive cross-sectional study carried out at the PEU at Kenyatta National Hospital (KNH) among 49 healthcare workers. The study participants were selected based on the quota sampling technique. Data was collected using self-administered questionnaire and observation checklist. The quantitative data was entered into an excel spread sheet and exported to STATA for statistical analysis. The results were presented in frequency and percentages in tables and graphs. Greenhouse Geisser (G-G) and fisher statistical test were used to test associations of the frequency of performance, challenges and knowledge among different cadres on nutritional assessment practices. The study established that 29.52 % of the health care workers had knowledge that weight loss was a critical indicator of patient nutritional status. As the results showed, 38.64% of the health workers had some training on assessment of nutrition status of HIV/AIDS children. The study results revealed that 90.3% of the Nurses had attempted two of the required four observations for the first, second and third patients respectively. A total of 9.7% and 3.2% of the Nurses made only one observation out of the required 4 observations for patient 1 and patient 3 respectively. Half of the clinicians didn’t attempt any of the listed 16 observations required for patient1 while 78.6% didn’t attempt for patient 2 and 57.1% not attempting any for the third patient. Heavy workload and inadequate equipment were reported by 23.19% and 18.84% of the respondents respectively as the biggest challenge to good nutritional assessment. Despite all the challenges, 98% of the respondents agreed that nutritional assessment for pediatric emergency patients is necessary. Study results revealed significant difference between cadre performance on nutritional assessment (p=0.028) where the nurses demonstrated the best performance. There was a significant association between accessibility of nutritional equipment and performance of nutritional assessment by healthcare workers (p=0.034) where healthcare workers with access to equipment were 7.1 times more likely to perform nutritional assessment compared to those without. The study concludes that there is inadequate and incomplete nutritional assessment due to insufficient knowledge in nutrition assessment, heavy work load and lack of adequate equipment as observed at the pediatric unit. Despite these impediments, health workers have positive attitude towards nutritional assessment. The study recommends that measures should be instigated to improve and facilitate efficient nutritional assessment of the pediatric patients.