Health Workers’ Practices, Barriers, and Facilitators to Nutrition Risk Assessment in Critically Ill Adults at Mbarara Regional Referral Hospital: A Sequential Explanatory Mixed-Methods Study

Health Workers’ Practices, Barriers, and Facilitators to Nutrition Risk Assessment in Critically Ill Adults at Mbarara Regional Referral Hospital: A Sequential Explanatory Mixed-Methods Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Health Workers’ Practices, Barriers, and Facilitators to Nutrition Risk Assessment in Critically Ill Adults at Mbarara Regional Referral Hospital: A Sequential Explanatory Mixed-Methods Study Daphine Asaasira, Philis Chelimo, Loyce Kyarikunda, Jacob Twinamatsiko, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7429048/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Malnutrition in critically ill adults accelerates catabolism, heightens infection risk, prolongs ICU stays, and increases mortality. Early Nutrition Risk Assessment (NRA) within 24–48 hours of admission is globally recommended to reduce these complications, yet its uptake remains low in resource-limited settings. The study assessed health workers’ practices, barriers and facilitators of nutrition risk assessment of critically ill adult patients at Mbarara Regional Referral Hospital (MRRH), Uganda. Methods We employed a sequential explanatory mixed-methods design. Quantitatively, using systematic random sampling, 322 ICU and Emergency Unit records (July 2023–July 2024) were reviewed using a 23-item Nutrition Risk Assessment documentation review checklist. Qualitatively, 16 purposively sampled health workers underwent in-depth interviews. Quantitative data were analyzed with STATA 17, and qualitative data underwent thematic analysis. Results Only 7.1% of records showed comprehensive NRA documentation; 92.9% were incomplete. Biochemical markers (hemoglobin, MCV) were recorded in 82%, whereas anthropometry and clinical exams were documented in < 2%. Key barriers included absence of standardized protocols, inadequate equipment (e.g., bed scales, portable weighing scales), high workload, and patient financial constraints. The primary facilitator was health workers’ self-directed nutrition knowledge. Conclusion NRA practices at MRRH are critically suboptimal. Implementation of context-adapted guidelines/ protocols, prioritization of nutrition risk assessment in daily rounds and the provision of adequate resources are required. Health Workers Practices Barriers Facilitators Nutrition Risk Assessment Critically Ill Adult Patients Introduction Malnutrition among critically ill patients is a pressing global health issue (Coruja et al., 2020, Egan et al., 2022 , Wang et al., 2021 ). Global prevalence rates range from 2–65% in hospitalized adults and 38–78% in ICUs (Cass and Charlton, 2022 ), escalating to 8–85% in Africa (Visser et al., 2024 ). Furthermore, Sub-Saharan regions may face even higher undocumented rates (Domenech-Briz et al., 2023). The condition triggers rapid catabolic deterioration, leading to 10–25% protein loss within 10 days of admission and significantly increasing risks of infection, multi-organ failure, prolonged hospitalization, and mortality (Koekkoek and van Zanten, 2017). The consequences are severe, with ICU mortality rates reaching 87% for high-risk patients compared to 49% for low-risk individuals (Zhang et al., 2021 ). Despite available screening tools like the Nutrition Risk in the Critically Ill score (NUTRIC score) and Nutrition Risk Assessment 2002 (NRS 2002)(Javid et al., 2021), malnutrition remains underdiagnosed due to inconsistent implementation. This is particularly true in resource-limited settings like Mbarara Regional Referral Hospital (MRRH) (Asiimwe et al., 2015 ), where no standardized protocols exist. At MRRH, delayed nutritional assessments and the absence of structured screening protocols contribute to poor patient outcomes, with reported mortality rates of 53% among malnourished patients (Asiimwe et al., 2015 ). Although international guidelines recommend nutrition risk evaluation within 24–48 hours of ICU admission (Siobal and Baltz, 2021 ), several barriers such as insufficient training, workforce shortages, and lack of support supervision hinder effective implementation (Degefa et al., 2021 , Hoffmann et al., 2020 ). Conversely, facilitators like training programs, collaborative partnerships, and availability of protocols and assessment tools have been shown to improve practice (Degefa et al., 2021 ). However, a critical gap remains in understanding health workers' current practices, challenges, and enabling factors for nutrition assessment specifically at MRRH. This study therefore, seeks to assess health workers’ practices, barriers, and facilitators to nutrition risk assessment among critically ill adult patients at MRRH. Methodology Study site and Study design This study was conducted at Mbarara Regional Referral Hospital (MRRH) in western Uganda, serving as a tertiary referral and teaching hospital with a capacity of 350 beds (Munezero et al., 2018). The focus was on the ICU and Emergency Unit, which frequently accommodate critically ill patients. A sequential explanatory mixed-methods design was employed, combining a quantitative retrospective cross-sectional study of patient records (Ranganathan and Aggarwal, 2018) with qualitative in-depth interviews to explore factors influencing nutrition risk assessment practices (Othman et al., 2020). Study Population and Sample Size For the quantitative arm, patient records from July 2023 to July 2024 were analyzed, including only those of adults admitted for at least 24 hours with critical illnesses. The qualitative arm targeted health workers in the ICU and Emergency Unit who had been working for a minimum of two months and consented to participate. The sample size for the quantitative component was determined to be 322 records, calculated using the Morgan and Krejcie table (Krejcie and Morgan, 1970). The qualitative component aimed for data saturation, and 16 participants were interviewed. Interviews with 9-17 participants can give sufficient data (Hennink and Kaiser, 2022). Sampling Method and Procedure Systematic random sampling was used to select patient records, ensuring an unbiased sample. Purposive sampling identified key informants among health workers for qualitative insights (Truong et al., 2020). Data collection involved a nutrition risk assessment documentation review checklist and semi-structured interviews. Data Collection Tools Quantitative data were gathered using a checklist focusing on social demographics and four domains of practice: anthropometry, biochemical markers, clinical/dietary history, and clinical exams. Qualitative data were collected through semi-structured interviews, allowing for in-depth exploration of barriers and facilitators. Questions like; what tools or guidelines do you use for conducting nutrition risk assessments? How is nutrition risk assessment addressed during ward rounds? Were asked. Quality Control and Data Analysis Quality control measures included expert validation of tools and a pilot study, achieving a Cronbach’s Alpha of 0.73. Data were analyzed using STATA for quantitative aspects and thematic analysis for qualitative insights. All data were securely stored to ensure confidentiality. Ethical Considerations Ethical approval was granted by the Research Ethical Committee (REC) (MUST-2024-1485) and the administration of MRRH. Informed consent was obtained from all participants, ensuring voluntary participation. Strict confidentiality measures were put in place Dissemination Plan Findings will be shared with study participants, MRRH administration, the Department of Nursing, and the University library (of MUST) and through conferences and publications to contribute to the existing knowledge in the field. Results Quantitative Findings Social Demographics, N=322 patient records Category F (%) Gender Males 197 61.2 Females 125 38.8 Age 18-28 66 20.2 29-38 57 17.8 39-48 57 17.8 >48 142 44.2 Cadre of admitting health worker MO 42 13.0 SHO 82 25.5 NURSE 1 0.31 INTERN DR. 197 61.2 Length of hospital stay 1wk 48 14.9 Mean (SD) 4.7 (4.0) Most of the records of the critically ill patients were for males with 61.2% with largest age group of over 48 years (44.2%). Most of patients were admitted by intern doctors (61.2%) and the length of hospital stay for most patients was an average 4.7 (4.0) days. Overall documented practice of the health Workers Practices Frequency Percentage (%) Good (70% and above) 23 7.1 Poor (0-69%) 299 92.9 Total 322 100 Documented practice was good in 23 (7.1%) of patient records and poor in 299 (92.9%). Overall documented practice of nutrition risk assessment among the different cadres of admitting health workers. Cadre of admitting health worker Number of health workers Level of practice 0-69% 70% and above MOs 42 36 (85.7%) 6 (14.3%) SHOs 82 71 (86.6%) 11 (13.4%) Intern Doctors 197 191 (97%) 6 (3.0%) Nurses 01 1 (100%) 0 (0%) The majority of the health workers had poor (0-69%) documented practice of nutrition risk assessment. Practice of each domain regarding Nutrition Risk Assessment by the various admitting cadre of health workers. Cadre Practice Anthropometry [f (%)] Biochemical markers [f (%)] Clinical/dietary history [f (%)] Clinical exam [f (%)] Total MOs Done 2 (4.8) 2 (4.8) 4 (9.5) 1 (2.4) 42 Not done 40 (95.2) 40 (95.2) 38 (90.5) 41 (97.6) SHOs Done 2 (2.4) 14 (17.1) 11 (13.4) 1 (1.2) 82 Not done 80 (97.6) 68 (82.9) 71 (86.6) 81 (98.8) NURSE Done 0 (0) 0 (0) 0 (0) 0 (0) 1 Not done 1 (100) 1 (100) 1 (100) 1 (100) INTERN DR. Done 2 (1.0) 14 (7.1) 4 (2.0) 2 (1.0) 197 Not done 195 (99.0) 183 (92.9) 193 (98.0) 195 (99.0) MOs had a higher performance of clinical/dietary history (9.5%), SHOs had a higher performance of biochemical markers and clinical/dietary exam (17.1% & 13.4% respectively) and also intern doctors had a higher performance of biochemical markers (7.1%). No nurses didn’t perform Nutrition Risk Assessment. Qualitative Findings Summary of participants’ demographic characteristics, N=16 Participant Age Sex Qualification Department Experience P1 50 F RN A & E 5 years P2 39 F RN ICU 2 years P3 44 F MNS ICU 2 years P4 29 M SHO ICU 11 months P5 29 M SHO ICU 2 years P6 28 M Intern Dr. A & E 6 months P7 27 M Intern Dr. A & E 6 months P8 26 F Intern Dr. A & E 6 months P9 32 F SHO ICU 3 years P10 43 M SHO ICU 2 years P11 29 M Intern Dr. A & E 6 months P12 28 M Intern Dr. A & E 6 months P13 32 F SHO A & E 2 years P14 32 M MMED A & E 5 years P15 33 M RN A & E 8 years P16 44 F BSCN A & E 2 years Summary of themes and subthemes on Barriers and Facilitators to Nutrition Risk Assessment of the Critically Ill Adult Patients at MRRH. Barriers Theme one: Health Facility-related factors. This theme merged from several subthemes which included: inadequate human resource, unavailability of protocols/ guidelines, inadequate equipment, inadequate infrastructure and inadequate training/CMEs. Inadequate human resource. Many of the participants identified inadequate human resources as a significant hindrance to nutrition risk assessment. Participants pointed out that insufficient staffing, especially a lack of dedicated nutritionists specifically for the Emergency unit hinders the formation of a multidisciplinary team that is essential for nutrition risk assessment. “… you find that you are alone and you have to do everything so you find some things are missed out…” P.2 “… it’s supposed to be a multi-disciplinary team where you are supposed to be having a dietitian, nutritionist, physician, a surgeon so that as one is dealing with one thing, the other is dealing with another thing...” P.12 “...I don't think I've seen a nutritionist. And I've been here for five years of my medical school, plus internship. I've never seen one. I think maybe they are at Mulago since they have a nutritionist school. Or in pediatrics . ..” P.8 Unavailability of protocols/guidelines and information resources. Most participants highlighted a lack of protocols and guidelines for nutrition risk assessment in the wards. They said that without visual reminders, they often overlook nutrition assessments, focusing instead on the primary reasons for patient admission. One participant emphasized the insufficient information available, which diminishes the perceived importance of nutrition risk assessment. “… if we can have posters just like we have ICU care bundles so if they are widely spread then you remember you have to do this every day …” P.2 “…We do not have enough write-ups; we do not have enough literature to make us think that this is important…it reduces mortality or length of hospital stay…”P.8 Inadequate infrastructure. The issue of inadequate infrastructure also came up during the interviews. One of the participants pointed out that pediatric ward has a nutrition unit which takes care of the nutritional needs of children and this reminds health workers that nutrition assessment is a must which is not so for adult patients. “… for example pediatrics has a nutrition unit itself and you really have to assess…but now here, we don’t have a nutrition unit for adults…” P.11 Inadequate equipment. While some participants said there were equipment to use, many of them mentioned that inadequate equipment is a significant hindrance to nutrition risk assessment. They said that Accident and Emergency unit and ICU lack essential tools, including weighing scales, height measuring boards, MUAC tapes, and BMI wheels. ICU participants specifically highlighted the need for beds that can measure weight, as many critically ill patients are unable to stand on traditional scales for weight assessment. “… of course you know there are no tools on emergency...I haven’t seen a weighing scale...” P.12 “… in our settings, getting a weighing scale is a challenge and if you’re going to do nutrition assessment with estimates it means you’re going to get it wrong…” P.6 “… we don’t go ahead to look at the weight here for our patients because of mobility issues, our beds do not take automatic weight…” P.6 “… Ideally it’s supposed to be done but since these patients come when they are critically ill but all that could be done in terms of the bed that measures…”P.5 “…our triage is not well facilitated to help us with that because if it could help us in taking the weight, height and calculating the BMI, maybe taking a MUAC where there is need to take it and maybe if the patient comes with that, a mere look could give you a hint on going for the Nutrition Risk Assessment…”P.7 Inadequate training/CMEs. Some participants highlighted inadequate training and the lack of continuous medical education (CME) focused on nutrition as a challenge. They said that while the hospital organizes CMEs, none have addressed nutrition assessment, leaving a significant gap. Although some Senior House Officers mentioned that nutrition risk assessment is included in their tutorials, this does not address the knowledge gap among other healthcare workers directly involved in patient care. “…we have not got any training that focused on Nutrition Risk Assessment. We have got others on general things maybe physical examinations and what but not nutrition risk assessment...” P.7 “...for a fact the hospital carries a lot of CME’s so the department of Internal Medicine does the same, carries out a lot of CME’s but none of the them have been about adult nutrition..” P.7 “… we have discussions, tutorials so for the resident’s side, yes…”P.5 “… if we could have staff who are specifically trained in nutrition assessment…” P.16 Theme Two: Health Worker related factors This theme emerged from the following subthemes: workload, lack of prioritization of Nutrition risk assessment. Workload. Workload came up as another factor that hinders nutrition risk assessment. Participants said that because of the overwhelming number of patients, they attend to the primary reason the patient came to the hospital and others like nutrition assessment are left to be done on the ward. “… because at times we are overwhelmed by patients and we look at the emergency part of it… it becomes very hard for you to look at the nutritional aspect…” P.15 “… you find that you are alone and you have to do everything so you find some things are missed out…” P.2 Lack of prioritization of nutrition risk assessment. Some health workers believe nutrition risk assessment is not a priority since it does not address the immediate reasons for a patient's hospital admission and is viewed as a non-urgent issue. Additionally, one participant noted that a cultural norm exists where they do not perform nutrition assessments because their seniors do not prioritize them either. “… we don’t assess the nutrition we only manage what brought the patient to the hospital...” P.15 “... to be honest it’s not really done because most of these patients come with different other comorbidities so assessment for nutrition comes in as a by the way...” P.12 “... it's not a routine thing we have seen our seniors do...those before us didn't do it, they didn't initiate us to do it, so we don't do it...”P.8 “... it’s really not always immediate as its not out major concern in the emergency department, it’s not something we address immediately .. . the time when we get concerned is when a patient is critically ill and wasted and in most cases, if we don’t have physical wasting we don’t go ahead to assess the nutritional side of the patient, if they look wasted, that’s when we assess the factors of nutrition… nutrition is not an urgent issue here…”P.6 “… we usually never give it a thought because these patients come in as emergencies most of the times so our interest mainly is controlling ABC and working on what has brought the patient…”P.7 Theme three: Patient-related factors. This theme emerged from three subthemes; financial constraints, severity of the illness and mobility issues. Financial constraints. Several participants identified inadequate funding as a hindrance to nutrition risk assessment, particularly for essential biochemical tests like CBC, Albumin, RBS, and serum electrolytes. One participant noted that families often cannot afford these tests, forcing healthcare workers to make assessments without complete information, while another mentioned that repeated test requests that go unfulfilled eventually lead to disengagement from requesting them altogether. “… sometimes the attendants get financial constraints, they cannot do all the tests and …sometimes the patient will tell you they cannot afford it so you just work blindly…” P.4 “…they should make the tests from the lab at a free cost and possibly even their feeding, NMS (National Medical Stores) can take it up…”P.4 “…many miss out because of the cost…”P.6 “... the biggest challenge, really, is that even though you might know someone who is already nutritionally malnourished or anything, it also has a challenge because they are in most instances unable to afford what could save them in that moment...”P.8 “...you can't go for those blood markers because as you go in you need to pay and it’s the patients who pay for them…”P.10 “... biochemical tests you would probably carry out, are not really very affordable…”P.13 “...you realize our people don't have money, which also becomes a big challenge…”P.3 Severity of the illness. Some of the participants said that most of the patients received at the emergency unit and ICU are very critical so health workers concentrate on what is life threatening since nutrition issues are not going to kill the patient there and then. “...you could be on a patient and the condition changes and it’s a cardiac arrest and there are certain things that you are going to overlook...”P.5 “...we don’t assess the nutrition we only manage what brought the patient to the hospital…”P.15 “...I realize it’s like we focus on the illness and the patient is chronically ill due to a certain reason it’s not something we rush for most times that’s all I can say, generally the assessment is poor…” P.11 “...So we don't have enough time to actually maybe think nutrition because our patients are acute, we manage them very quickly and then from there they are already for other orders...”P.13 “...So, while they are here, the first initial thing is to care for their matters, the situation at hand that has brought them…. even if they have that nutritional thing, it is not the first thing that we intervene in the first 24 hours, no...” P.9 Mobility issues. Another issue that came up was that usually the patients received in these units are very ill and unable to move or stand so it because hard to take their weight using a traditional weighing scale since there are no beds to take their weight automatically hence nutrition assessment isn’t done. “... we don’t go ahead to look at the weight here for our patients because of mobility issues, our beds do not take automatic weight…” P.6 Facilitators. Health worker-related factors: Knowledge of parameters of nutrition risk assessment. The majority of participants demonstrated knowledge of nutrition risk assessment, recognizing MUAC and BMI as key components. The majority said they engage in self-directed literature searches online and utilize educational materials to enhance patient care, while one senior house officer reported that their department conducts discussions and tutorials on nutrition risk assessment. “....we take their MUAC, weight, height to also guide if the person is losing or gaining...” P.2 “… so what we usually do is what we base on from our own literature, you search up journals, you read about Nutrition Risk Assessment...” P.4 “… we have discussions, tutorials so for the resident’s side, yes…”P.5 Discussion Overall, health workers’ practices regarding nutrition risk assessment at Mbarara Regional Referral Hospital were poor, consistent with findings from (Hadera et al., 2022 , Lyu et al., 2021 ), which reported low assessment rates among health workers. Among different cadres, Medical Officers (MOs) performed slightly better (14.3%) than Senior House Officers (SHOs) (13.4%) and Intern Doctors (3.0%), while nurses had no documented assessments. This contrasts with a Kenyan study showing high assessment frequencies among nurses (Ndiema, 2021 ). The discrepancy may be attributed to nurses not admitting patients, limiting their engagement in assessments (Moriel et al., 2017 , Torrens et al., 2020 ). Biochemical markers were the most frequently assessed, particularly by SHOs, while clinical exams were neglected due to a lack of protocols and training. Financial constraints limited access to necessary tests, aligning with (Degefa et al., 2021 ). Inadequate infrastructure, high patient-to-staff ratios, and heavy workloads also hindered assessments (Hoffmann et al., 2020 , Mehta et al., 2018 ). Moreover, the lack of dedicated dietitians and training further compromised nutrition risk assessment (Avgerinou et al., 2020 ). Despite these challenges, knowledge of assessment parameters like MUAC and BMI emerged as a facilitator. MOs and SHOs performed better in clinical and dietary histories, while no nurses engaged in these practices due to perceived roles and responsibilities. Overall, the study highlights significant gaps in nutrition risk assessment practices among health workers, emphasizing the need for improved training, resources, and collaborative care models Limitations Nutrition risk assessment practices could have been done, but not documented. This was mitigated by conducting face-to-face interviews with the health workers. Conclusion Nutrition Risk Assessment in critically ill adults at MRRH is inadequately performed due to modifiable structural, health worker, and patient factors. Strategic implementation of context-adapted protocols, essential equipment, prioritization of nutrition risk assessment in daily rounds, and policy-driven lab subsidies is imperative to integrate nutrition as a core component of critical care. Recommendations Development and dissemination of easy-to-use NRA protocols, procurement of bed scales and portable weighing scales and other necessary equipment and prioritizing NRA during ward rounds. Declarations Ethics approval granted by MUST-REC (Ref. MUST-2024-1485). All participants provided informed consent. No conflicts of interest declared. Ethics approval and consent to participate This study was conducted in accordance with the principles outlined in the Declaration of Helsinki. Approval was granted by the Research Ethics Committee of Mbarara Regional Referral University on 14th May 2024, reference MUST-2024-1485. Informed consent was obtained from all individual participants included in the study Consent for publication Not applicable. The manuscript does not contain any person’s data in any form. Competing interests The authors have no competing interests. Funding The authors did not receive any support from any organization for the submitted work. Author Contribution A.D*.Conceptualisation, methodology, analysis, and wrote the main manuscript textP.C. Data analysisL.K.Data analysisJ.T. Data collectionS.N.Data collection V.N.MethodologyR.L.Methodology, analysis, and supervision. All the authors reviewed and edited the manuscript. Acknowledgements The authors would like to thank Mr. Grant Katureebe with visualization. We also thank the participants of the study for their time and contribution. Data Availability The datasets used during the current study are available from the corresponding author on request. References ASIIMWE, S. B., AMIR, A., VITTINGHOFF, E. & MUZOORA, C. K. 2015. 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The modified NUTRIC score can be used for nutritional risk assessment as well as prognosis prediction in critically ill COVID-19 patients. Clinical Nutrition, 40 , 534-541. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 06 Oct, 2025 Editor invited by journal 29 Aug, 2025 Editor assigned by journal 24 Aug, 2025 Submission checks completed at journal 24 Aug, 2025 First submitted to journal 21 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7429048","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":530679862,"identity":"131951a8-53c7-418e-9e50-f84124c4724b","order_by":0,"name":"Daphine Asaasira","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYLCCBAYGxgYGHiCrAoiZmRtI0XIGpIWRCC0MMC2MbVA2PsDff/jxh4d77GT7Z/cee/BxXm00fztQy4+KbTi1SNxIM5NIeJZsPOPOuXTDmduO5844zNjA2HPmNm5rbjCYMSQcYE5suJFjJs277VhuA1ALM2Mbbi3y549//pBwoD5xPkjL3znHcucT0mJwIMdAIuHA4cQNIC2MDTW5GwhpMbyRUwbUctx4450zZpI9xw7kbgRqOYjPL3Lnj2/++ONAtey82z1mEj9q6nLnnT988MGPCjzehwMJMHkYTB4gQj1cSx1xikfBKBgFo2BEAQBbKmRCIbq+6wAAAABJRU5ErkJggg==","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":true,"prefix":"","firstName":"Daphine","middleName":"","lastName":"Asaasira","suffix":""},{"id":530679863,"identity":"2a1035a8-54e2-4ad5-8bfa-6840ddaa278f","order_by":1,"name":"Philis Chelimo","email":"","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Philis","middleName":"","lastName":"Chelimo","suffix":""},{"id":530679864,"identity":"b180c738-9d39-44e4-a28d-e92c88f22d1a","order_by":2,"name":"Loyce Kyarikunda","email":"","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Loyce","middleName":"","lastName":"Kyarikunda","suffix":""},{"id":530679865,"identity":"983db81e-c850-495c-a65e-14ece944f2f5","order_by":3,"name":"Jacob Twinamatsiko","email":"","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Jacob","middleName":"","lastName":"Twinamatsiko","suffix":""},{"id":530679866,"identity":"3897605c-49e5-4510-b27a-6c274c9a2182","order_by":4,"name":"Shamia Nakabugo","email":"","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Shamia","middleName":"","lastName":"Nakabugo","suffix":""},{"id":530679867,"identity":"8509cf11-91df-4168-aba4-e67ad9ce322e","order_by":5,"name":"Vallence Niyonzima","email":"","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Vallence","middleName":"","lastName":"Niyonzima","suffix":""},{"id":530679868,"identity":"b8d27162-ced5-43f6-b60f-b11fbccd3309","order_by":6,"name":"Rachel Luwaga","email":"","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Rachel","middleName":"","lastName":"Luwaga","suffix":""}],"badges":[],"createdAt":"2025-08-21 20:08:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7429048/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7429048/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":93805553,"identity":"81470ca5-d7c8-4195-9c45-1f42cc873d6d","added_by":"auto","created_at":"2025-10-17 18:01:05","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":62417,"visible":true,"origin":"","legend":"","description":"","filename":"MANUSCRIPT.docx","url":"https://assets-eu.researchsquare.com/files/rs-7429048/v1/ca13df474518b7554317c66c.docx"},{"id":93805554,"identity":"b60986b2-ef22-4e92-89bd-76f6fbb84dee","added_by":"auto","created_at":"2025-10-17 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18:01:05","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":92501,"visible":true,"origin":"","legend":"","description":"","filename":"67d0747317aa4b3eb47131f4c466be081structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7429048/v1/3245a23ae1c0fe92a2c70f36.xml"},{"id":93805556,"identity":"c326e679-5ffb-4a82-a482-b758e928b5da","added_by":"auto","created_at":"2025-10-17 18:01:05","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":102792,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7429048/v1/aa31953426773f1e7e116933.html"},{"id":93806303,"identity":"df2513e0-b665-47e2-ba4f-b51e2564d249","added_by":"auto","created_at":"2025-10-17 18:09:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1036287,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7429048/v1/06d9ea1b-a633-44a3-994a-f910befa9a9a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Health Workers’ Practices, Barriers, and Facilitators to Nutrition Risk Assessment in Critically Ill Adults at Mbarara Regional Referral Hospital: A Sequential Explanatory Mixed-Methods Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMalnutrition among critically ill patients is a pressing global health issue (Coruja et al., 2020, Egan et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2022\u003c/span\u003e, Wang et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Global prevalence rates range from 2\u0026ndash;65% in hospitalized adults and 38\u0026ndash;78% in ICUs (Cass and Charlton, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), escalating to 8\u0026ndash;85% in Africa (Visser et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Furthermore, Sub-Saharan regions may face even higher undocumented rates (Domenech-Briz et al., 2023). The condition triggers rapid catabolic deterioration, leading to 10\u0026ndash;25% protein loss within 10 days of admission and significantly increasing risks of infection, multi-organ failure, prolonged hospitalization, and mortality (Koekkoek and van Zanten, 2017). The consequences are severe, with ICU mortality rates reaching 87% for high-risk patients compared to 49% for low-risk individuals (Zhang et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Despite available screening tools like the Nutrition Risk in the Critically Ill score (NUTRIC score) and Nutrition Risk Assessment 2002 (NRS 2002)(Javid et al., 2021), malnutrition remains underdiagnosed due to inconsistent implementation. This is particularly true in resource-limited settings like Mbarara Regional Referral Hospital (MRRH) (Asiimwe et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), where no standardized protocols exist.\u003c/p\u003e\u003cp\u003eAt MRRH, delayed nutritional assessments and the absence of structured screening protocols contribute to poor patient outcomes, with reported mortality rates of 53% among malnourished patients (Asiimwe et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Although international guidelines recommend nutrition risk evaluation within 24\u0026ndash;48 hours of ICU admission (Siobal and Baltz, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), several barriers such as insufficient training, workforce shortages, and lack of support supervision hinder effective implementation (Degefa et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e, Hoffmann et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Conversely, facilitators like training programs, collaborative partnerships, and availability of protocols and assessment tools have been shown to improve practice (Degefa et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). However, a critical gap remains in understanding health workers' current practices, challenges, and enabling factors for nutrition assessment specifically at MRRH.\u003c/p\u003e\u003cp\u003eThis study therefore, seeks to assess health workers\u0026rsquo; practices, barriers, and facilitators to nutrition risk assessment among critically ill adult patients at MRRH.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003e\u003cstrong\u003eStudy site and Study design \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted at Mbarara Regional Referral Hospital (MRRH) in western Uganda, serving as a tertiary referral and teaching hospital with a capacity of 350 beds (Munezero et al., 2018). The focus was on the ICU and Emergency Unit, which frequently accommodate critically ill patients.\u003c/p\u003e\n\u003cp\u003eA sequential explanatory mixed-methods design was employed, combining a quantitative retrospective cross-sectional study of patient records (Ranganathan and Aggarwal, 2018) with qualitative in-depth interviews to explore factors influencing nutrition risk assessment practices (Othman et al., 2020).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Population and Sample Size\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor the quantitative arm, patient records from July 2023 to July 2024 were analyzed, including only those of adults admitted for at least 24 hours with critical illnesses. The qualitative arm targeted health workers in the ICU and Emergency Unit who had been working for a minimum of two months and consented to participate.\u003c/p\u003e\n\u003cp\u003eThe sample size for the quantitative component was determined to be 322 records, calculated using the Morgan and Krejcie table (Krejcie and Morgan, 1970). The qualitative component aimed for data saturation, and 16 participants were interviewed. Interviews with 9-17 participants can give sufficient data (Hennink and Kaiser, 2022).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling Method and Procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSystematic random sampling was used to select patient records, ensuring an unbiased sample. Purposive sampling identified key informants among health workers for qualitative insights (Truong et al., 2020). Data collection involved a nutrition risk assessment documentation review checklist and semi-structured interviews.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection Tools\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQuantitative data were gathered using a checklist focusing on social demographics and four domains of practice: anthropometry, biochemical markers, clinical/dietary history, and clinical exams. Qualitative data were collected through semi-structured interviews, allowing for in-depth exploration of barriers and facilitators. Questions like; what tools or guidelines do you use for conducting nutrition risk assessments? How is nutrition risk assessment addressed during ward rounds? Were asked.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuality Control and Data Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQuality control measures included expert validation of tools and a pilot study, achieving a Cronbach\u0026rsquo;s Alpha of 0.73. Data were analyzed using STATA for quantitative aspects and thematic analysis for qualitative insights. All data were securely stored to ensure confidentiality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was granted by the Research Ethical Committee (REC) (MUST-2024-1485) and the administration of MRRH. Informed consent was obtained from all participants, ensuring voluntary participation. Strict confidentiality measures were put in place\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDissemination Plan\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFindings will be shared with study participants, MRRH administration, the Department of Nursing, and the University library (of MUST) and through conferences and publications to contribute to the existing knowledge in the field.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eQuantitative Findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp id=\"_Toc193719508\"\u003eSocial Demographics, N=322 patient records\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eF\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eMales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e197\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e61.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eFemales\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e125\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e38.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e18-28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e66 \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e20.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e29-38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e57\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e17.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e39-48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e57\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e17.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026gt;48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e44.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eCadre of admitting health worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eMO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e42\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e13.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eSHO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e82\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e25.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eNURSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eINTERN DR.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e197\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e61.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eLength of hospital stay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026lt;1wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e274\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e85.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026gt;1wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e48 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e14.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e4.7 (4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eMost of the records of the critically ill patients were for males with 61.2% with largest age group of over 48 years (44.2%). \u0026nbsp;Most of patients were admitted by intern doctors (61.2%) and the length of hospital stay for most patients was an average 4.7 (4.0) days.\u003c/p\u003e\n\u003cp\u003eOverall documented practice of the health Workers\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003ePractices\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eFrequency\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eGood (70% and above)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003ePoor (0-69%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e92.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e322\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eDocumented practice was good in 23 (7.1%) of patient records and poor in 299 (92.9%).\u003c/p\u003e\n\u003cp\u003eOverall documented practice of nutrition risk assessment among the different cadres of admitting health workers.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eCadre of admitting health worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eNumber of health workers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eLevel of practice\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0-69%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e70% and above\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eMOs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e36 \u0026nbsp; (85.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e6 \u0026nbsp;(14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eSHOs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e71 \u0026nbsp; (86.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e11 (13.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eIntern Doctors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e191 (97%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e6 \u0026nbsp; (3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eNurses\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1 \u0026nbsp; \u0026nbsp; (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe majority of the health workers had poor (0-69%) documented practice of nutrition risk assessment.\u003c/p\u003e\n\u003cp\u003ePractice of each domain regarding Nutrition Risk Assessment by the various admitting cadre of health workers.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"600\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eCadre\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003ePractice\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eAnthropometry\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[f (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eBiochemical markers\u003c/p\u003e\n \u003cp\u003e[f (%)]\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eClinical/dietary history\u003c/p\u003e\n \u003cp\u003e[f (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eClinical exam\u003c/p\u003e\n \u003cp\u003e[f (%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eMOs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eDone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e2 \u0026nbsp; (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e2 \u0026nbsp; \u0026nbsp; (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e4 \u0026nbsp; \u0026nbsp; (9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1 \u0026nbsp; \u0026nbsp; (2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eNot done\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e40 (95.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e40 \u0026nbsp; (95.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e38 \u0026nbsp; (90.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e41 \u0026nbsp; (97.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eSHOs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eDone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e2 \u0026nbsp; (2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e14 \u0026nbsp; (17.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e11 \u0026nbsp; (13.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1 \u0026nbsp; \u0026nbsp; (1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eNot done\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e80 (97.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e68 \u0026nbsp; (82.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e71 \u0026nbsp; (86.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e81 \u0026nbsp; (98.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eNURSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eDone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp;(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eNot done\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e1 \u0026nbsp; \u0026nbsp;(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1 \u0026nbsp; \u0026nbsp; (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e1 \u0026nbsp; \u0026nbsp; (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1 \u0026nbsp; \u0026nbsp; (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eINTERN DR.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eDone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e2 \u0026nbsp; \u0026nbsp;(1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e14 \u0026nbsp; (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e4 \u0026nbsp; \u0026nbsp; (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2 \u0026nbsp; \u0026nbsp; (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e197\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eNot done\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e195 (99.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e183 (92.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e193 (98.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e195 (99.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eMOs had a higher performance of clinical/dietary history (9.5%), SHOs had a higher performance of biochemical markers and clinical/dietary exam (17.1% \u0026amp; 13.4% respectively) and also intern doctors had a higher performance of biochemical markers (7.1%).\u003c/p\u003e\n\u003cp\u003eNo nurses didn\u0026rsquo;t perform Nutrition Risk Assessment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQualitative Findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSummary of participants\u0026rsquo; demographic characteristics, N=16\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eParticipant\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eQualification\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDepartment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eExperience\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eP1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eA \u0026amp; E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eP2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eP3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eP4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSHO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11 months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eP5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSHO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eP6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIntern Dr.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eA \u0026amp; E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eP7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIntern Dr.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eA \u0026amp; E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eP8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIntern Dr.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eA \u0026amp; E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eP9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSHO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eP10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSHO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eP11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIntern Dr.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eA \u0026amp; E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eP12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIntern Dr.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eA \u0026amp; E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eP13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSHO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eA \u0026amp; E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eP14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMMED\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eA \u0026amp; E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eP15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eA \u0026amp; E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eP16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBSCN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eA \u0026amp; E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2 id=\"_Toc195689338\"\u003eSummary of themes and subthemes on Barriers and Facilitators to Nutrition Risk Assessment of the Critically Ill Adult Patients at MRRH.\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eBarriers\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme one: Health Facility-related factors.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme merged from several subthemes which included: inadequate human resource, unavailability of protocols/ guidelines, inadequate equipment, inadequate infrastructure and inadequate training/CMEs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInadequate human resource.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMany of the participants identified inadequate human resources as a significant hindrance to nutrition risk assessment. Participants pointed out that insufficient staffing, especially a lack of dedicated nutritionists specifically for the Emergency unit hinders the formation of a multidisciplinary team that is essential for nutrition risk assessment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip; you find that you are alone and you have to do everything so you find some things are missed out\u0026hellip;\u0026rdquo; P.2\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026nbsp;\u003c/em\u003e\u003cem\u003eit\u0026rsquo;s supposed to be a multi-disciplinary team where you are supposed to be having a dietitian, nutritionist, physician, a surgeon so that as one is dealing with one thing, the other is dealing with another thing...\u0026rdquo; P.12\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u0026ldquo;...I don\u0026apos;t think I\u0026apos;ve seen a nutritionist. And I\u0026apos;ve been here for five years of my medical school, plus internship. I\u0026apos;ve never seen one.\u003c/em\u003e\u003cem\u003e\u0026nbsp;I think maybe they are at Mulago since they have a nutritionist school. Or in pediatrics .\u003c/em\u003e\u003cem\u003e..\u0026rdquo; P.8\u003c/em\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUnavailability of protocols/guidelines and information resources.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMost participants highlighted a lack of protocols and guidelines for nutrition risk assessment in the wards. They said that without visual reminders, they often overlook nutrition assessments, focusing instead on the primary reasons for patient admission. One participant emphasized the insufficient information available, which diminishes the perceived importance of nutrition risk assessment.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip; if we can have posters just like we have ICU care bundles so if they are widely spread then you remember you have to do this every day \u0026hellip;\u0026rdquo; P.2\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;We do not have enough write-ups; we do not have enough literature to make us think that this is important\u0026hellip;it reduces mortality or length of hospital stay\u0026hellip;\u0026rdquo;P.8\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInadequate infrastructure.\u0026nbsp;\u003c/strong\u003eThe\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eissue of inadequate infrastructure also came up during the interviews. One of the participants pointed out that pediatric ward has a nutrition unit which takes care of the nutritional needs of children \u0026nbsp;and this reminds health workers that nutrition assessment is a must which is not so for adult patients.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip; for example pediatrics has a nutrition unit itself and you really have to assess\u0026hellip;but now here, we don\u0026rsquo;t have a nutrition unit for adults\u0026hellip;\u0026rdquo; P.11\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInadequate equipment.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhile some participants said there were equipment to use, many of them mentioned that inadequate equipment is a significant hindrance to nutrition risk assessment. They said that Accident and Emergency unit and ICU lack essential tools, including weighing scales, height measuring boards, MUAC tapes, and BMI wheels. ICU participants specifically highlighted the need for beds that can measure weight, as many critically ill patients are unable to stand on traditional scales for weight assessment.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip; of course you know there are no tools on emergency...I haven\u0026rsquo;t seen a weighing scale...\u0026rdquo; P.12\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip; in our settings, getting a weighing scale is a challenge and if you\u0026rsquo;re going to do nutrition assessment with estimates it means you\u0026rsquo;re going to get it wrong\u0026hellip;\u0026rdquo; P.6\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u003c/em\u003e\u003cem\u003ewe don\u0026rsquo;t go ahead to look at the weight here for our patients because of mobility issues, our beds do not take automatic weight\u0026hellip;\u0026rdquo; P.6\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u0026ldquo;\u0026hellip;\u003c/em\u003e\u003cem\u003eIdeally it\u0026rsquo;s supposed to be done but since these patients come when they are critically ill but all that could be done in terms of the bed that measures\u0026hellip;\u0026rdquo;P.5\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;our triage is not well facilitated to help us with that because if it could help us in taking the weight, height and calculating the BMI, maybe taking a MUAC where there is need to take it and maybe if the patient comes with that, a mere look could give you a hint on going for the Nutrition Risk Assessment\u0026hellip;\u0026rdquo;P.7\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInadequate training/CMEs.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSome participants highlighted inadequate training and the lack of continuous medical education (CME) focused on nutrition as a challenge. They said that while the hospital organizes CMEs, none have addressed nutrition assessment, leaving a significant gap. Although some Senior House Officers mentioned that nutrition risk assessment is included in their tutorials, this does not address the knowledge gap among other healthcare workers directly involved in patient care.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;we have not got any training that focused on Nutrition Risk Assessment. We have got others on general things maybe physical examinations and what but not nutrition risk assessment...\u0026rdquo; \u0026nbsp;P.7\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;...for a fact the hospital carries a lot of CME\u0026rsquo;s so the department of Internal Medicine does the same, carries out a lot of CME\u0026rsquo;s but none of the them have been about adult nutrition..\u0026rdquo; P.7\u003c/em\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u003c/em\u003e\u003cem\u003ewe have discussions, tutorials so for the resident\u0026rsquo;s side, yes\u0026hellip;\u0026rdquo;P.5\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026nbsp;\u003c/em\u003e\u003cem\u003eif we could have staff who are specifically trained in nutrition assessment\u0026hellip;\u0026rdquo; P.16\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme Two: Health Worker related factors \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme emerged from the following subthemes: workload, lack of prioritization of Nutrition risk assessment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWorkload.\u0026nbsp;\u003c/strong\u003eWorkload came up as another factor that hinders nutrition risk assessment. Participants said that because of the overwhelming number of patients, they attend to the primary reason the patient came to the hospital and others like nutrition assessment are left to be done on the ward.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u0026ldquo;\u0026hellip; because at times we are overwhelmed by patients and we look at the emergency part of it\u0026hellip; it becomes very hard for you to look at the nutritional aspect\u0026hellip;\u0026rdquo; P.15\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip; you find that you are alone and you have to do everything so you find some things are missed out\u0026hellip;\u0026rdquo; P.2\u003c/em\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLack of prioritization of nutrition risk assessment.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSome health workers believe nutrition risk assessment is not a priority since it does not address the immediate reasons for a patient\u0026apos;s hospital admission and is viewed as a non-urgent issue. Additionally, one participant noted that a cultural norm exists where they do not perform nutrition assessments because their seniors do not prioritize them either.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u0026ldquo;\u0026hellip; we don\u0026rsquo;t assess the nutrition we only manage what brought the patient to the hospital...\u0026rdquo; P.15\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;... to be honest it\u0026rsquo;s not really done because most of these patients come with different other comorbidities so assessment for nutrition comes in as a by the way...\u0026rdquo; P.12\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;...\u003c/em\u003e\u003cem\u003eit\u0026apos;s not a routine thing we have seen our seniors do...those before us didn\u0026apos;t do it, they didn\u0026apos;t initiate us to do it, so we don\u0026apos;t do it...\u0026rdquo;P.8\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;...\u003c/em\u003e\u003cem\u003eit\u0026rsquo;s really not always immediate as its not out major concern in the emergency department, it\u0026rsquo;s not something we address immediately\u003c/em\u003e..\u003cem\u003e.\u003c/em\u003e\u003cem\u003ethe time when we get concerned is when a patient is critically ill and wasted and in most cases, if we don\u0026rsquo;t have physical wasting we don\u0026rsquo;t go ahead to assess the nutritional side of the patient, if they look wasted, that\u0026rsquo;s when we assess the factors of nutrition\u0026hellip; nutrition is not an urgent issue here\u0026hellip;\u0026rdquo;P.6\u003c/em\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u003c/em\u003e\u003cem\u003ewe usually never give it a thought because these patients come in as emergencies most of the times so our interest mainly is controlling ABC and working on what has brought the patient\u0026hellip;\u0026rdquo;P.7\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme three: Patient-related factors.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme emerged from three subthemes; financial constraints, severity of the illness and mobility issues.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial constraints.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeveral participants identified inadequate funding as a hindrance to nutrition risk assessment, particularly for essential biochemical tests like CBC, Albumin, RBS, and serum electrolytes. One participant noted that families often cannot afford these tests, forcing healthcare workers to make assessments without complete information, while another mentioned that repeated test requests that go unfulfilled eventually lead to disengagement from requesting them altogether.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u0026ldquo;\u0026hellip; sometimes the attendants get financial constraints, they cannot do all the tests and \u0026hellip;sometimes the patient will tell you they cannot afford it so you just work blindly\u0026hellip;\u0026rdquo; P.4\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;they should make the tests from the lab at a free cost and possibly even their feeding, NMS (National Medical Stores) can take it up\u0026hellip;\u0026rdquo;P.4\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;many miss out because of the cost\u0026hellip;\u0026rdquo;P.6\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;...\u003c/em\u003e\u003cem\u003ethe biggest challenge, really, is that even though you might know someone who is already nutritionally malnourished or anything, it also has a challenge because they are in most instances unable to afford what could save them in that moment...\u0026rdquo;P.8\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;...you can\u0026apos;t go for those blood markers because as you go in you need to pay and it\u0026rsquo;s the patients who pay for them\u0026hellip;\u0026rdquo;P.10\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;...\u0026nbsp;\u003c/em\u003e\u003cem\u003ebiochemical tests you would probably carry out, are not really very affordable\u0026hellip;\u0026rdquo;P.13\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;...you realize our people don\u0026apos;t have money, which also becomes a big challenge\u0026hellip;\u0026rdquo;P.3\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSeverity of the illness.\u0026nbsp;\u003c/strong\u003eSome of the participants said that\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003emost of the patients received at the emergency unit and ICU are very critical so health workers concentrate on what is life threatening since nutrition issues are not going to kill the patient there and then.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;...you could be on a patient and the condition changes and it\u0026rsquo;s a cardiac arrest and there are certain things that you are going to overlook...\u0026rdquo;P.5\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;...we don\u0026rsquo;t assess the nutrition we only manage what brought the patient to the hospital\u0026hellip;\u0026rdquo;P.15\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;...I realize it\u0026rsquo;s like we focus on the illness and the patient is chronically ill due to a certain reason it\u0026rsquo;s not something we rush for most times that\u0026rsquo;s all I can say, generally the assessment is poor\u0026hellip;\u0026rdquo; P.11\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u0026ldquo;...So we don\u0026apos;t have enough time to actually maybe think nutrition because our patients are acute, we manage them very quickly and then from there they are already for other orders...\u0026rdquo;P.13\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;...So, while they are here, the first initial thing is to care for their matters, the situation at hand that has brought them\u0026hellip;. even if they have that nutritional thing, it is not the first thing that we intervene in the first 24 hours, no...\u0026rdquo; P.9\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMobility issues.\u0026nbsp;\u003c/strong\u003eAnother issue that came up was that usually the patients received in these units are very ill and unable to move or stand so it because hard to take their weight using a traditional weighing scale since there are no beds to take their weight automatically hence nutrition assessment isn\u0026rsquo;t done.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;... we don\u0026rsquo;t go ahead to look at the weight here for our patients because of mobility issues, our beds do not take automatic weight\u0026hellip;\u0026rdquo; P.6\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFacilitators.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHealth worker-related factors: Knowledge of parameters of nutrition risk assessment.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe majority of participants demonstrated knowledge of nutrition risk assessment, recognizing MUAC and BMI as key components. The majority said they engage in self-directed literature searches online and utilize educational materials to enhance patient care, while one senior house officer reported that their department conducts discussions and tutorials on nutrition risk assessment.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;....we take their MUAC, weight, height to also guide if the person is losing or gaining...\u0026rdquo; P.2\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip; so what we usually do is what we base on from our own literature, you search up journals, you read about Nutrition Risk Assessment...\u0026rdquo; P.4\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u003c/em\u003e\u003cem\u003ewe have discussions, tutorials so for the resident\u0026rsquo;s side, yes\u0026hellip;\u0026rdquo;P.5\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOverall, health workers\u0026rsquo; practices regarding nutrition risk assessment at Mbarara Regional Referral Hospital were poor, consistent with findings from (Hadera et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2022\u003c/span\u003e, Lyu et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), which reported low assessment rates among health workers. Among different cadres, Medical Officers (MOs) performed slightly better (14.3%) than Senior House Officers (SHOs) (13.4%) and Intern Doctors (3.0%), while nurses had no documented assessments. This contrasts with a Kenyan study showing high assessment frequencies among nurses (Ndiema, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). The discrepancy may be attributed to nurses not admitting patients, limiting their engagement in assessments (Moriel et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2017\u003c/span\u003e, Torrens et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eBiochemical markers were the most frequently assessed, particularly by SHOs, while clinical exams were neglected due to a lack of protocols and training. Financial constraints limited access to necessary tests, aligning with (Degefa et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eInadequate infrastructure, high patient-to-staff ratios, and heavy workloads also hindered assessments (Hoffmann et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2020\u003c/span\u003e, Mehta et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Moreover, the lack of dedicated dietitians and training further compromised nutrition risk assessment (Avgerinou et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite these challenges, knowledge of assessment parameters like MUAC and BMI emerged as a facilitator. MOs and SHOs performed better in clinical and dietary histories, while no nurses engaged in these practices due to perceived roles and responsibilities.\u003c/p\u003e\u003cp\u003eOverall, the study highlights significant gaps in nutrition risk assessment practices among health workers, emphasizing the need for improved training, resources, and collaborative care models\u003c/p\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eNutrition risk assessment practices could have been done, but not documented. This was mitigated by conducting face-to-face interviews with the health workers.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eNutrition Risk Assessment in critically ill adults at MRRH is inadequately performed due to modifiable structural, health worker, and patient factors. Strategic implementation of context-adapted protocols, essential equipment, prioritization of nutrition risk assessment in daily rounds, and policy-driven lab subsidies is imperative to integrate nutrition as a core component of critical care.\u003c/p\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eRecommendations\u003c/h2\u003e\u003cp\u003eDevelopment and dissemination of easy-to-use NRA protocols, procurement of bed scales and portable weighing scales and other necessary equipment and prioritizing NRA during ward rounds.\u003c/p\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval granted by MUST-REC (Ref. MUST-2024-1485). All participants provided informed consent. No conflicts of interest declared.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThis study was conducted in accordance with the principles outlined in the Declaration of Helsinki. Approval was granted by the Research Ethics Committee of Mbarara Regional Referral University on 14th May 2024, reference MUST-2024-1485. Informed consent was obtained from all individual participants included in the study\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eNot applicable. The manuscript does not contain any person\u0026rsquo;s data in any form.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors have no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThe authors did not receive any support from any organization for the submitted work.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eA.D*.Conceptualisation, methodology, analysis, and wrote the main manuscript textP.C. Data analysisL.K.Data analysisJ.T. Data collectionS.N.Data collection V.N.MethodologyR.L.Methodology, analysis, and supervision. All the authors reviewed and edited the manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eThe authors would like to thank Mr. Grant Katureebe with visualization. We also thank the participants of the study for their time and contribution.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe datasets used during the current study are available from the corresponding author on request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eASIIMWE, S. B., AMIR, A., VITTINGHOFF, E. \u0026amp; MUZOORA, C. K. 2015. Causal impact of malnutrition on mortality among adults hospitalized for medical illness in sub-Saharan Africa: what is the role of severe sepsis? \u003cem\u003eBMC Nutrition,\u003c/em\u003e 1\u003cstrong\u003e,\u003c/strong\u003e 25.\u003c/li\u003e\n\u003cli\u003eAVGERINOU, C., BHANU, C., WALTERS, K., CROKER, H., TUIJT, R., REA, J., HOPKINS, J., KIRBY-BARR, M. \u0026amp; KHARICHA, K. 2020. 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The modified NUTRIC score can be used for nutritional risk assessment as well as prognosis prediction in critically ill COVID-19 patients. \u003cem\u003eClinical Nutrition,\u003c/em\u003e 40\u003cstrong\u003e,\u003c/strong\u003e 534-541.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nutrition","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nutn","sideBox":"Learn more about [BMC Nutrition](http://bmcnutr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nutn/default.aspx","title":"BMC Nutrition","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Health Workers, Practices, Barriers, Facilitators, Nutrition Risk Assessment, Critically Ill, Adult Patients","lastPublishedDoi":"10.21203/rs.3.rs-7429048/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7429048/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eMalnutrition in critically ill adults accelerates catabolism, heightens infection risk, prolongs ICU stays, and increases mortality. Early Nutrition Risk Assessment (NRA) within 24\u0026ndash;48 hours of admission is globally recommended to reduce these complications, yet its uptake remains low in resource-limited settings. The study assessed health workers\u0026rsquo; practices, barriers and facilitators of nutrition risk assessment of critically ill adult patients at Mbarara Regional Referral Hospital (MRRH), Uganda.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe employed a sequential explanatory mixed-methods design. Quantitatively, using systematic random sampling, 322 ICU and Emergency Unit records (July 2023\u0026ndash;July 2024) were reviewed using a 23-item Nutrition Risk Assessment documentation review checklist. Qualitatively, 16 purposively sampled health workers underwent in-depth interviews. Quantitative data were analyzed with STATA 17, and qualitative data underwent thematic analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOnly 7.1% of records showed comprehensive NRA documentation; 92.9% were incomplete. Biochemical markers (hemoglobin, MCV) were recorded in 82%, whereas anthropometry and clinical exams were documented in \u0026lt;\u0026thinsp;2%. Key barriers included absence of standardized protocols, inadequate equipment (e.g., bed scales, portable weighing scales), high workload, and patient financial constraints. The primary facilitator was health workers\u0026rsquo; self-directed nutrition knowledge.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eNRA practices at MRRH are critically suboptimal. Implementation of context-adapted guidelines/ protocols, prioritization of nutrition risk assessment in daily rounds and the provision of adequate resources are required.\u003c/p\u003e","manuscriptTitle":"Health Workers’ Practices, Barriers, and Facilitators to Nutrition Risk Assessment in Critically Ill Adults at Mbarara Regional Referral Hospital: A Sequential Explanatory Mixed-Methods Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-17 18:01:00","doi":"10.21203/rs.3.rs-7429048/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-10-06T06:23:19+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-29T15:04:17+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-25T01:34:08+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-25T01:33:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nutrition","date":"2025-08-21T20:05:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nutrition","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nutn","sideBox":"Learn more about [BMC Nutrition](http://bmcnutr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nutn/default.aspx","title":"BMC Nutrition","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2895f794-e356-4e7e-be57-1ebd5c21929b","owner":[],"postedDate":"October 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-17T18:01:00+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-17 18:01:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7429048","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7429048","identity":"rs-7429048","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}