Teresa I. Pounds & Jessica A. Scott
According to a study conducted in Global Health Action (2014), malnutrition is one of the most prevalent public health concerns1 in West Africa, mainly noted in pediatric populations that range from stunted growth and low weight to higher risk factors of disability and even premature death. Although most countries within the West Africa region lack the appropriate funding and political backing for expansion of a nutrition awareness program, it has been noted namely Nigeria and Ghana have been the countries noted with the greatest capacities to support improvement of nutrition within a medical setting.
It has been observed that awareness of malnutrition overall is very low, leading to slower changes being brought about to improve conditions of malnutrition. Most importantly, malnutrition within the hospital setting is of the greatest concern of patients in Nigeria. Nutrition has been found to have significant effects on length of patient stay in hospitals, development of complications, and increased rates of morbidity and mortality.
Lack of standardized suppliers of specialized nutritional support (i.e. parenteral nutrition) and limited education on specialized nutritional support has led to the need for a proposed branch of ASPEN in West Africa, entitled WASPEN.
The presence of ASPEN within this region will help not only to provide funding for nutritional support but will provide backing for more research efforts to be done to increase awareness for malnutrition within this region.
Currently with the started initiative, there are 15 registered members to ASPEN, contributing towards the budding WASPEN chapter.
Hospital Experiences
Following the timeline listed in Table 1, six hospitals were audited for presence of specialized nutritional support.
Delta State University Teaching Hospital
Total Parenteral Nutrition (TPN) is provided. The Pharmacists is responsible for constitution and monitoring once there is a line. It was observed that specialized nutritional support should be multidisciplinary with various professionals making input – Physician observes needs and recommends TPN; Dieticians provide assessment of the problem; Pharmacist provide assessment of the problem, make up the formulation and monitors labs/therapy; Nurses provide daily monitoring, maintains the line, intake and output.
University College Ibadan
Nutrition support not fully established. An enteral nutrition group was set up. Challenges with TPN include availability, cost, pricing (N36000 –N38000), clinicians not fully aware of need etc.
Federal Medical Centre Owo
Nothing on ground yet with regards to TPN.
University of Port Harcourt Teaching Hospital
Some TPN provided but pharmacists are not involved.
University of Nigeria Teaching Hospital
No formal system on set up
University of Ilorin
Nothing on ground for TPN yet but Fortified pap used for enteral nutrition support
University of Ibadan
Not yet in practice but lecturers interested in including this in students curriculum. It was observed that Nutrition/ Metabolic Support is a Rotation in the US.
Current Research and Findings
A cross-sectional research study conducted by two pharmacists at a local hospital assessed the establishment of a specialized nutritional support program via a questionnaire. Special thanks are given to Dr. Ejiro Akpowwovwo and Dr. Odion-Obomhense Helen for their efforts.
Following a timeline set from November of 2018 listed in Table 1 (listed below), initiatives have been started.
| Description | Person Responsible | Timeline |
| Review what your institution is doing. Write this down and identify the gaps
(Issues around Training and collaboration will likely to be highlighted and Dr Pounds is available for support) |
All Institutions | As soon as possible |
| Questionnaires for baseline survey in Nigeria to be developed | Dr Pounds | 3 – 4 weeks |
| Nurses Screening and Dietician Assessment tools to be shared | 3 – 4 weeks | |
| Overview of Nutrition Support lecture to be shared | Dr Pounds | 3 – 4 weeks |
| Check availability of Paediatric Premix | Dr Pounds | 3 – 4 weeks |
| Available products should be reviewed | Product group | 3 months |
| Advocacy group – check affordability, donations as CSR, subsidized costs | Advocacy Group | 3 months |
| Conduct surveys and research. Disseminating questionnaires, Analyzing Results, Consider multi-centered study | Research group | Ongoing |
Table 1: Pharmacists during the November 2018 inaugural WASPEN meeting in Ibadan, Nigeria.
Timeline of Continued Changes
At this current time, ongoing research studies and study protocol development is in place to continue building awareness for specialized nutritional support and validating the need for the presence of APSEN in West Africa.
In addition, there are team leaders in three important groups of Advocacy and Cost, Research and Survey Group, and Product Group. To continue efforts towards developing WASPEN, 100 members of DELSUTH have indicated interest and have started to take the lead for advancement towards the goals of forming WASPEN.