Prevalence, impact, and management of adult disease-related malnutrition in African hospitals: a narrative review and insight from resource-limited clinical settings.

Disease-related malnutrition (DRM) is a worldwide problem regarded as a global policy priority, but occurs on an exaggerated scale in Africa. While interpretation of studies is difficult due to the variety of nutrition assessment techniques, DRM in acute care in-patient African settings is commonly reported in the range of 45-75%, with nutritional risk reaching 84%. Challenges to the comprehensive management of DRM in the resource-limited clinical settings with few dietitians reviewed in this paper include the following: first, lack of routine nutrition screening resulting in more than 90% of malnourished or at-risk patients failing to receive nutrition support referrals, or receiving very delayed referrals. The result is worsening of nutritional status during hospital stay, clinical complications two to six times higher, up to a doubling of length of stay, and significantly higher mortality. Second, hospital structures are generally unsupportive of worthwhile nutritional care due to very poor or absent provision of nutritious oral diets, lack of multidisciplinary insight and collaboration, and the nonexistence of formalized nutrition support protocols and standards. Third, there is a grave lack of medical nutrition therapy (MNT) products and feeding pumps, forcing dietitians to improvise suboptimal formulations for enteral and parenteral feeding. Where MNT is available it is expensive and often not reimbursed, placing the responsibility for acquisition onto patients' families at their own expense. Urgent improvements in nutrition protocols adapted for resource-constrained contexts are needed, along with political commitment to facilitate the supply of suitable MNT products and equipment for use in hospitals.