NURSES’ KNOWLEDGE IN THE MANAGEMENT OF MALNUTRITION IN CHILDREN AND ITS CHALLENGES IN BUEA REGIONAL HOSPITAL

Abstract

Malnutrition is a state of nutrition in which deficiency or excess of energy, protein and other nutrients causes measurable adverse effects on tissue and body form and function, and clinical outcome. It is one of the major causes of mortality worldwide, especially in children who are still undergoing growth and development.

Malnutrition can be managed and WHO/UNICEF have put forth guideline for managing the condtion. However, nurses may not be using this guidelines in managing these condition. This research is intended to examine the nurses’ Knowledge in the management of malnutrition in children and its challenges in the Buea Regional Hospital.

A cross sectional descriptive design was used for this study to carry out this study where nurses were conveniently sampled and those who accepted to be part of the study were given a self- administered questionnaire and the result analyzed using excel 2016. For the results, out of the 43 participants sampled, majority; 14 (32.6%) were between 30 and 35 years, The level of knowledeg on malnutrition was high as 86.0% had adequate knowledge while 14.0% had poor knowledge. There were no significant association between level of knowledeg and socio demographic variables.

Despite this high level of knowledge, only 34.9% of the respondent had ever heard of WHO/UNICEF guideline for managing malnutrition though 79.1% acknowledeg to have been involved in training on the management of malnutrition in children. The main challenges faced by nurses in the management of malnutrition was that of cultural diversity and lack of dialogue (95.3%) followed by lack of medical resources and lack of coperation (72.1%) each.

The findings arising from this study reveal that nurse’s knowledge levels on malnutrition, it causes and prevention of malnutrition in children was good. However, it generally highlight poor and inadequate knowledge levels on the management of malnutrition according to WHO/UNICEF’s guidelines. It can be recommended that refresher courses should be organized to update nurses on current events in case management of malnutrition and by extension of other pathologies.

CHAPTER ONE:

GENERAL INTRODUCTION

1.1. Background of Study

Koenet al(2009) defined malnutrition as a state of nutrition in which deficiency or excess of energy, protein and other nutrients causes measurable adverse effects on tissue and body form and function, and clinical outcome. In the early 1990s, results of the first epidemiological study on malnutrition showed that malnutrition potentiated the effects of infectious diseases on child mortality and population level.

The study confirmed that malnutrition has a multiplicative effect on mortality and taking into account the underlying causes of death, the results suggested that malnutrition was an associated cause in about one half of all children death in developing countries(Pelletier et al., 2013).

Majority of studies on child nutritional status have described prevalence of malnutrition among under five year children and analyzed socio-economic, demographic and cultural factors associated with child malnutrition in sub-Saharan Africa (Ponguetal, 2010). Studies have found a strong association between under nutrition and child mortality (Bhuttaetal, 2009).

Stunting, wasting and other forms of undernutrition contribute significantly to childhood mortality, disease and long-term disability to survivors (Ainsworth, 2010), (United Nations Children’s Fund, 2013). In addition, deficiencies relating to micronutrients such as vitamin A, iron and zinc increase the risk of morbidity and mortality in children. Apart from the immediate devastating effects of undernutrition on morbidity and mortality, undernutrition also causes delayed development affecting children’s cognitive development and outcomes and their productive capacity as adults (Ainsworth, 2010).

In 2011, 26% (165 million) of children under the age of five were stunted (low length or height for age) globally (United Nations Children’s Fund, 2013). Three fourths of these children live in sub-Saharan Africa and Asia.

Approximately 101 million children under the age of five were underweight (low-weight-for-age) in 2011 with about 21% of these children living in sub- Saharan Africa (United Nations Children’s Fund, 2013). One in seven Ghanaian children under the age of five was moderately or severely underweight; 23% moderately or severely stunted and 6% moderately or severely wasted (Ghana Statistical Service, 2011).

Some of these children become severely malnourished and are admitted to the hospital. Two million children were admitted for severe acute malnutrition (SAM) worldwide in 2011, with over 80% of them coming from sub-Saharan Africa (United Nations Children’s Fund, 2013). The risk of death is nine times more likely in malnourished children with or without complications than in well-malnourished children (Black et al., 2008).

Although prevention of SAM is paramount, its occurrence represents a medical emergency and requires urgent and special action to minimize complications and avoid the risk of death (Ashworth et al ., 2003).

Case fatality rates for the treatment of severe malnutrition in poor-resourced health centers have been reported to be at 20% – 30% for marasmus (wasting malnutrition) and about 50% – 60%  for kwashiorkor for the past 50 years (Collins et al ., 2006).

Since the 1970s, treatment and management protocols have been introduced and shown to have a capability of reducing case fatalities to as low as 1% – 5% (Ahmed et al ., 1996). One of such protocols is the World Health Organization and United Nations International Children’s Fund (WHO and UNICEF) guidelines for the inpatient treatment of severely malnourished children. The use of these guidelines by hospitals has resulted in a substantial reduction in mortality rates from 30% – 50% to 5% – 15% (Ashworth et al ., 2003).

Notwithstanding the positive outcomes of these guidelines as well as other protocols or guidelines in specialized units, their publication has not led to widespread decreases in case fatality rates in most hospitals in developing countries (Briend et al ., 2001). Inappropriate case management resulting from poor knowledge (Schofield et al ., 1996) has been attributed to the persistent high case fatality rates in developing countries. Evidence available indicates that the success and effectiveness of the guidelines depend on the availability of skilled and motivated health care staff (Brewster et al ., 1995).

The London school of hygiene and tropical medicine, (2009) classified malnutrition into two types namely: protein-energy malnutrition resulting from deficiencies in any or all nutrients and micronutrient deficiency diseases result from a deficiency of specific micronutrients. The National Health Service, (2013) characterized children with malnutrition as to have among many other signs, breathing difficulties, fatigue, tiredness, irritability. Once malnutrition is treated, adequate growth is an indication of health and recovery; even though after recovering from severe malnutrition, children often remain stunted for the rest of their lives (Walker, 2010).

A number of studies from sub-Saharan Africa (Buxton et al ., 2013) have investigated nurses’ knowledge and attitudes towards nutrition. These studies have found nurses to have positive attitudes towards nutrition but limited nutrition-related knowledge.

All of these studies have either investigated nurses’ knowledge and attitudes towards nutrition in general, or considered hospital malnutrition or nutrition of the elderly. Studies investigating nurses’ knowledge and attitudes towards malnutrition in children and its management are limited.

In our search of the literature, we came across only two studies, one from southern Ethiopia (Shele et al ., 2015) and the other from Guatemala (Hammond, 2014) that investigated health workers’ (with nurses inclusive) knowledge, attitude and practice towards malnutrition in children. The authors of both studies found health workers to have inadequate knowledge and skills in clinical nutrition topics although a large proportion of them had positive attitudes towards nutrition issues. Inadequate nutrition education during nursing training and lack of refresher training programmes have been noted for nurses’ poor knowledge in malnutrition.

In Ghana the case ain’t different. Investigated student nurses knowledge in nutrition found over 30% of the participants having inadequate knowledge Bruxton et al ., (2013).

In Cameroon the rate of malnutrition among children less than 5 years in both the Far North and East Region had around 65000 cases of severely malnourished children (95%) of the target were admitted to therapeutic care, of these, 46000 children or 71% were cured. However, in a normal term this region recorded one of the highest cases as compared to other regions which is suggested to be relatively low in Cameroon.

1.2. Statement of the problem

In Cameroon as well as other African less developed countries, a minority of nurses have knowledge in the management of malnutrition in children. But all through my study in the Buea Regional Hospital, the researcher discovered that a higher proportion of the nurse’s did not have a mastery knowledge on the WHO/UNICEF Guidelines in the management of malnutrition in children.

However, most of them have never been involved in any form of training in the management of malnutrition in respect to the afore mentioned guidelines, how to combat the difficulties they face, and hence this is the reason that prompted the researcher in carrying out this research to bring out possible solutions that will help the nurses to have adequate knowledge on the management and possible solution to combat the challenges.

 1.3 Research Questions

1. What is the level of nurses’ knowledge with regard to malnutrition in children in Buea Regional Hospital?
2. What are the WHO and UNICEF guidelines nurses’ in Buea Regional Hospital use in the management and prevention of malnutrition in children?
3. What challenges do the nurses face in implementing WHO and UNICEF guidelines in the management of malnutrition in children?