Addressing malnutrition for safer surgery: a single-center prospective cross-sectional study in Sub-Saharan Africa

Background: The prevalence of malnutrition among hospitalized patients in Africa ranges from 8% to 85%. Nutritional problems are common in perioperative time. Malnutrition has been identified as an independent and modifiable risk factor for poor surgical outcomes. This study aims to determine the prevalence of nutritional risk and disorders, to audit nutritional management, and to assess its impact on surgery. Methods: We conducted a prospective cross-sectional study of 6 months in a surgical ward of a level-2 hospital of sub-Saharan country. The study included all patients admitted to our department. The primary outcomes were prevalence of nutritional risk and nutritional disorders, nutritional management, and its impact on surgical care. Results: A total of 199 patients were included; 33.2% were women, and the sex ratio was 2.01. The mean age was 43.45 ± 19.3 years. Nutritional risk was prevalent at 27.6% of patients. A total of 23.1% ( n = 46) of patients had a body mass index below normal, 8.5% were obese, and 9.5% were severely underweight. Malnourished patients (both obese and underweight) represented 31.6% of patient. Intestinal obstruction accounted for 22.1% of patients. Admission was elective 39.7% and emergency 60.3%. Concerning nutritional management, only 13 (6.5%) of the patients received nutritional care, it was enteral supplement 1%, mixed 2.5%, parenteral 1%, and provided by the family 2%. Only five received nutritional management before surgery and all in a hospital setting. This represents 0.1% of patients at nutritional risk and 0.08% of malnourished patients. Mean postoperative fasting was 1.65 ± 1.66 days, and mean length of hospital stay was 4.91 ± 8.29 days. Several significant associations were found between different variables and postoperative outcomes. Conclusions: Nutritional risk is prevalent in our ward, and prevalence of underweight individuals is higher than that of obese. Nutritional risk and malnutrition are associated with negative outcomes after surgery. The main areas of intervention are staff training, systematic screening at all stages of treatment, establishment of institutional nutritional protocols, government action to make enteral and parenteral nutritional supplements available, conducting studies on locally available foods in order to adapt and include local foods in care, and finally, continuously evaluating results after intervention. In our case, we suffer from a lack of strategies adapted to our context. This could be addressed in global surgery projects, as preventing and treating malnutrition means offering safer surgery to patients.