TY - JOUR
T1 - Evaluation of a nutrition-risk screening tool in Lao PDR
T2 - Identifying malnutrition in a low-resource clinical setting
AU - Wilson, Hannah
AU - Cummings, Joanna
AU - Rasprasith, Slackchay
AU - Stadler, Diane
N1 - Funding Information:
This research was made possible through funding from the Vejdusit Foundation, Oregon Health & Science University (OHSU), and from private philanthropists. HW also received a travel award from OHSU Global to fund travel expenses to Lao PDR.
Publisher Copyright:
© 2020 European Society for Clinical Nutrition and Metabolism
PY - 2020/8
Y1 - 2020/8
N2 - Background & aims: Malnutrition is a top priority in Lao PDR. In 2017, 33% of children under five years of age were stunted, 21.1% were underweight, 9% were wasted while 16.6% of adults in community settings were malnourished. Rates of malnutrition are presumed to be higher among hospitalized patients however, malnutrition risk screening in inpatient settings does not occur in Lao PDR. To address this gap, this study aimed to determine the prevalence of malnutrition among hospitalized patients and investigated the inter-user reliability and validity of a nutrition-risk screening tool (NRST). Methods: A cross-sectional study of pediatric (n = 69) and adult (n = 125) patients was conducted at two hospitals in Vientiane, Lao PDR. Inter-observer reliability of the NRST was determined by comparing final scores of two independent observers. Validity of the NRST was determined using sensitivity, specificity, and area-under-the-receiver-operating-characteristics (ROC) curve analyses. Results: Among participants 0–4 years of age, 51% were diagnosed with malnutrition, while 58% of participants aged 5–17 years were malnourished. Among participants 18 years of age or older, 47% were diagnosed with moderate to severe malnutrition. The NRST showed ‘fair’ agreement between Observer 1 and Observer 2 NRST final scores (0.2737, p-value <0.001). Observer 1 and Observer 2 had a 64% and 70% probability of correctly distinguishing a malnourished from a not malnourished participant. The Lao NRST had a sensitivity of 85% and a specificity 35%. Conclusion: There is a high prevalence of malnutrition among hospitalized patients in Lao PDR. This study provides proof of concept that a nutrition-risk screening tool can be successfully administered in a low-resource setting. Timely identification of malnutrition among newly admitted hospitalized patients will help minimize adverse patient health outcomes and reduce the economic burden of healthcare in Lao PDR.
AB - Background & aims: Malnutrition is a top priority in Lao PDR. In 2017, 33% of children under five years of age were stunted, 21.1% were underweight, 9% were wasted while 16.6% of adults in community settings were malnourished. Rates of malnutrition are presumed to be higher among hospitalized patients however, malnutrition risk screening in inpatient settings does not occur in Lao PDR. To address this gap, this study aimed to determine the prevalence of malnutrition among hospitalized patients and investigated the inter-user reliability and validity of a nutrition-risk screening tool (NRST). Methods: A cross-sectional study of pediatric (n = 69) and adult (n = 125) patients was conducted at two hospitals in Vientiane, Lao PDR. Inter-observer reliability of the NRST was determined by comparing final scores of two independent observers. Validity of the NRST was determined using sensitivity, specificity, and area-under-the-receiver-operating-characteristics (ROC) curve analyses. Results: Among participants 0–4 years of age, 51% were diagnosed with malnutrition, while 58% of participants aged 5–17 years were malnourished. Among participants 18 years of age or older, 47% were diagnosed with moderate to severe malnutrition. The NRST showed ‘fair’ agreement between Observer 1 and Observer 2 NRST final scores (0.2737, p-value <0.001). Observer 1 and Observer 2 had a 64% and 70% probability of correctly distinguishing a malnourished from a not malnourished participant. The Lao NRST had a sensitivity of 85% and a specificity 35%. Conclusion: There is a high prevalence of malnutrition among hospitalized patients in Lao PDR. This study provides proof of concept that a nutrition-risk screening tool can be successfully administered in a low-resource setting. Timely identification of malnutrition among newly admitted hospitalized patients will help minimize adverse patient health outcomes and reduce the economic burden of healthcare in Lao PDR.
KW - Clinical nutrition
KW - Lao PDR
KW - Low-resource
KW - Malnutrition
KW - Screening
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U2 - 10.1016/j.clnesp.2020.05.023
DO - 10.1016/j.clnesp.2020.05.023
M3 - Article
C2 - 32690186
AN - SCOPUS:85087116617
SN - 2405-4577
VL - 38
SP - 99
EP - 110
JO - Clinical Nutrition ESPEN
JF - Clinical Nutrition ESPEN
ER -