Introducing a nutritional risk screening tool in a South African hospital

Ndhlovu, Lesego
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Background: Nutritional screening facilitates the early identification of hospitalised children at risk of malnutrition. Screening tools have scarcely been evaluated in the developing world where the burden of malnutrition is greatest. Methods: This was a retrospective study of 113 patients admitted to the general paediatric wards at Rahima Moosa Mother and Child Hospital in Johannesburg, South Africa (SA). Children 6 months – 14 years old were screened for malnutrition using anthropometry and correlating WHO z-scores, and retrospectively assessed for nutritional risk using a modified STAMP (mSTAMP). Results: The mSTAMP identified additional patients at nutritional risk. The majority (87%) of children with normal anthropometry scored as medium and high risk using the mSTAMP. Weight loss and length of hospital stay were higher in medium and high risk groups: One (10%) low risk child lost weight, compared to eight (47%) medium and 12 (26%) high risk children (p= 0.028). Low risk children had a median length of stay of two days (IQR : 1.5 – 5.5) compared to medium and high risk groups with medians of three (IQR: 2 – 6) and six (IQR: 4 – 10) days respectively (p= 0.04). Conclusion: The mSTAMP identified more children at risk of malnutrition. These children may not have been considered for nutritional therapy during the hospital stay using anthropometry screening alone. There is a place for nutritional risk screening in developing world settings, but tools may need to be modified locally. Further studies and validation of these tools in Sub-Saharan Africa seem prudent and may result in improved nutrition and outcomes of hospitalised children.
A research report submitted in partial fulfilment of the requirements for the degree of Master of Medicine in Paediatrics and Child Health to the Faculty of Health Science, University of the Witwatersrand, Johannesburg, 2020