Experiences of health professionals with nutritional support of critically ill patients in tertiary hospitals in Malawi

Background 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. Results 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 challenges identified. Conclusion 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.

Complications associated with malnutrition in elective surgical patients in a Malaysian setting

Purpose: To identify the level of malnutrition and complications observed in Malaysia. Methods: A prospective, observational study was conducted with the objectives of identifying the degree of malnutrition, complications and the need for nutritional support in elective surgical patients. Collection of data was performed in local tertiary hospitals using a Patient Generated Subjective Global Assessment (PG - SGA) nutritional screening tool and medical records. Results: A total of 50 patients electively admitted for surgery were included. The results demonstrated that there was a significant increase in malnourished patients post-surgery compared to pre-surgery (p = 0.0001). Most interesting was the significant number of complications observed post-surgery compared to pre-surgery (p = 0.035) which was associated to the poor level of nutrition. The most common type of complications noted post-surgery were nosocomial infection, wound infection and readmission. Conclusion: Malnutrition is prevalent pre- and post-operatively in Malaysia. Therefore, focus on the outcome of these malnourished patients should be performed to reduce complications associated with poor nutrition.

Nutritional profile and yield of oyster mushroom cultivated on selected agricultural wastes

Research on mushroom production and products is gaining more grounds globally and in particular Nigeria. This study was carried out to determine nutritional relationship between the substrate used for cultivation and the fruiting body on each of the substrates. Agro-wastes, namely: palm ( Elaeis guineensis ) fruit shaft, plantain ( Musa paradisiaca ) leaves, sawdust and kenaf ( Hibiscus cannabinus ) stem, were assessed for suitability as substrates for cultivation of oyster mushroom ( Pleurotus floridanus Singer ). The spawn of the mushroom was used to inoculate each of the substrates, using a complete randomised design, with five replicates for each substrate. Results showed that all the substrates supported mycelia growth and development of fruiting bodies of the fungus. There were significant differences (P<0.05) among substrates in terms of number of days to complete mycelia run, with the least recorded in palm fruit shaft (25.20), and the highest in kenaf (32.40). Total yield also differed significantly (P<0.05), with the highest in palm fruit shaft (51.4 g 100 g-1) and lowest in plantain leaves (6.0 g 100 g-1). There was also significant difference (P<0.05) in the nutritional content of fruiting bodies, the highest fat content being on plantain leaves (1.72 g 100 g-1) and the lowest on palm fruit shaft (0.55 g 100 g-1). The trend was similar for mushroom substrates, plantain leaves having (2.55 g 100 g-1) and palm fruit shaft, (0.41g 100 g-1). Starch content for fruiting bodies was highest on sawdust (5.31 g 100 g-1) and lowest on kenaf (2.66 g 100 g-1), while for mushroom substrates, kenaf was (0.33g 100 g-1) and palm fruit shaft was (4.45g 100 g-1). There was a positive correlation (r = 0.24) between the nutrient of fruiting bodies and that of the substrate on which it was cultivated.