title: Experiences of health professionals with nutritional support of critically ill patients in tertiary hospitals in Malawi.
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Human Nutrition and Health, Faculty of Food and Human Sciences, Lilongwe University of Agriculture and Natural Resources (LUANAR) and Department of Paediatrics, Kamuzu Central Hospital, Lilongwe, Malawi.
authors.forename: A
authors.initials: A
authors.lastname: Bunyani
authors.affiliation: Department of Human Nutrition and Health, Faculty of Food and Human Sciences, Lilongwe University of Agriculture and Natural Resources (LUANAR), Lilongwe, Malawi.
authors.forename: B
authors.initials: B
authors.lastname: Mtimuni
authors.affiliation: Department of Human Nutrition and Health, Faculty of Food and Human Sciences, Lilongwe University of Agriculture and Natural Resources (LUANAR), Lilongwe, Malawi.
authors.forename: A
authors.initials: A
authors.lastname: Kalimbira
authors.affiliation: Department of Surgery, Faculty of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: P
authors.initials: P
authors.lastname: Kamalo
mesh_terms: D000328:Adult; D000368:Aged; D002648:Child; D003422:Critical Care / Q000379:methods* / Q000592:standards; D016638:Critical Illness / Q000453:epidemiology / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D006282:Health Personnel; D006801:Humans; D007407:Interviews as Topic; D008295:Malawi; D009752:Nutritional Status; D018529:Nutritional Support / Q000379:methods*; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers; D016896:Treatment Outcome