Addressing the Growing Need for Specialized Nutritional Support in West Africa
Malnutrition remains one of the most significant public health challenges in West Africa. According to research published in Global Health Action (2014), malnutrition continues to affect vulnerable populations, particularly children, contributing to conditions such as stunted growth, low body weight, increased disability risks, and premature mortality.
Despite the widespread impact of malnutrition, many countries across the West African region continue to face challenges in establishing effective nutrition awareness programs due to limited funding, insufficient healthcare resources, and inadequate policy support. However, countries such as Nigeria and Ghana have demonstrated strong potential to lead improvements in clinical nutrition practices and the development of structured nutritional support systems.
Within healthcare facilities, awareness and recognition of malnutrition remain limited. This lack of awareness can delay appropriate interventions and negatively affect patient outcomes. Hospital malnutrition is particularly concerning because inadequate nutritional support has been associated with longer hospital stays, increased complications, higher healthcare costs, and greater morbidity and mortality rates.
The Need for a West African Chapter of ASPEN
The absence of standardized specialized nutritional support systems, including limited access to parenteral nutrition (PN), coupled with inadequate education and training among healthcare professionals, has highlighted the urgent need for a dedicated regional organization focused on clinical nutrition.
To address these challenges, a proposed West African chapter of the American Society for Parenteral and Enteral Nutrition (ASPEN) was introduced: WASPEN (West African Society for Parenteral and Enteral Nutrition).
The establishment of WASPEN aims to:
- Improve awareness of malnutrition and clinical nutrition practices across West Africa.
- Promote education and professional development in specialized nutritional support.
- Encourage multidisciplinary collaboration among healthcare professionals.
- Support research initiatives focused on improving nutritional care.
- Advocate for improved access, affordability, and availability of nutritional products.
Through collaboration with ASPEN, the WASPEN initiative will provide a platform for advancing evidence-based nutrition care and strengthening healthcare systems throughout the region.
Currently, the initiative has attracted 15 registered ASPEN members, representing the foundation of the emerging WASPEN chapter.
Hospital Experiences and Assessment of Specialized Nutritional Support Services
As part of the initial assessment process, six hospitals across Nigeria were reviewed to evaluate the availability and implementation of specialized nutritional support programs.
Delta State University Teaching Hospital (DELSUTH)
Total Parenteral Nutrition (TPN) services are available at DELSUTH. Pharmacists are responsible for preparing formulations and monitoring therapy once vascular access is established.
The assessment highlighted the importance of a multidisciplinary approach to nutritional support involving:
- Physicians: Identify patients requiring nutritional intervention and prescribe TPN when appropriate.
- Dietitians: Conduct nutritional assessments and develop dietary care plans.
- Pharmacists: Prepare formulations, monitor laboratory parameters, and evaluate therapy effectiveness.
- Nurses: Provide daily patient monitoring, manage access lines, and monitor fluid intake and output.
A coordinated multidisciplinary nutrition support team was identified as essential for achieving optimal patient outcomes.
University College Hospital, Ibadan
A nutrition support system has not been fully established, although an enteral nutrition group has been created.
Challenges identified with TPN implementation include:
- Limited availability.
- High cost (approximately ₦36,000–₦38,000 per treatment).
- Pricing challenges.
- Limited awareness among clinicians regarding the importance of specialized nutritional support.
Federal Medical Centre, Owo
No formal specialized nutritional support program was currently available.
University of Port Harcourt Teaching Hospital
Some TPN services are provided; however, pharmacists are not actively involved in the management process.
University of Nigeria Teaching Hospital (UNTH)
No formal nutritional support system has been established.
University of Ilorin
No TPN program is currently available. However, fortified pap has been used as an approach for enteral nutritional support.
University of Ibadan
Specialized nutritional support is not yet part of routine clinical practice. However, faculty members have expressed interest in incorporating nutrition support education into healthcare training programs.
It was also noted that nutrition and metabolic support rotations are incorporated into healthcare education programs in the United States, highlighting an opportunity for curriculum development in West Africa.
Current Research and Findings
A cross-sectional research study conducted by pharmacists at a local hospital evaluated the current status and readiness for establishing specialized nutritional support programs through a structured questionnaire.
Special appreciation is extended to:
- Dr. Ejiro Akpowwovwo
- Dr. Odion-Obomhense Helen
for their contributions toward advancing this important area of research.
Following the inaugural WASPEN meeting held in Ibadan, Nigeria, in November 2018, a strategic action plan was developed to guide the growth of specialized nutritional support services.
Initial WASPEN Development Plan
| Initiative | Responsible Group | Timeline |
|---|---|---|
| Review current institutional nutrition practices and identify gaps, particularly in training and collaboration | All Institutions | Immediate |
| Develop baseline survey questionnaires for Nigerian healthcare institutions | Dr. Pounds | 3–4 weeks |
| Share nursing screening and dietitian assessment tools | Nutrition Team | 3–4 weeks |
| Provide introductory nutrition support education materials | Dr. Pounds | 3–4 weeks |
| Assess availability of pediatric premix formulations | Dr. Pounds | 3–4 weeks |
| Review available nutritional products | Product Group | 3 months |
| Establish advocacy initiatives focused on affordability, donations, corporate social responsibility, and subsidized access | Advocacy Group | 3 months |
| Conduct surveys, analyze findings, and develop multicenter research projects | Research Group | Ongoing |
Continued Progress and Future Directions
The WASPEN initiative continues to expand through ongoing research activities, protocol development, and educational efforts aimed at increasing awareness of specialized nutritional support across West Africa.
Three major working groups have been established to support the development of the organization:
1. Advocacy and Cost Group
Focused on improving access to nutritional products through partnerships, funding opportunities, and affordability initiatives.
2. Research and Survey Group
Responsible for conducting studies, collecting data, and generating evidence to support improved nutrition care practices.
3. Product Group
Focused on evaluating the availability, accessibility, and suitability of specialized nutritional products within the region.
In addition, approximately 100 members of Delta State University Teaching Hospital (DELSUTH) have expressed interest in supporting the advancement of WASPEN and contributing toward the establishment of a strong professional network for clinical nutrition in West Africa.
Building a Stronger Future for Nutrition Care in West Africa
The creation of WASPEN represents an important step toward improving nutritional care, strengthening healthcare education, and developing sustainable specialized nutrition support systems throughout West Africa.
Through collaboration, research, advocacy, and professional development, WASPEN aims to transform the way malnutrition is recognized and managed within healthcare settings across the region.