Undernutrition and associated factors among older adults in Ethiopia: systematic review and meta-analysis

Comorbidities, level of education, and alcohol consumption are predictive factors of undernutrition among adult outpatients living with diabetes: a case at Hawassa governmental hospitals in Ethiopia

Comorbidities, which are additional health conditions that occur alongside diabetes, can have a significant effect on blood sugar control. These conditions often complicate the management of diabetes and worsen overall health. Malnutrition, on the other hand, is a common concern for people with diabetes due to difficulties with food intake and metabolism. Proper nutrition is crucial for maintaining general health and effectively managing the disease. However, the extent of comorbidities and malnutrition within this group is not well understood in the study area. A cross-sectional study was conducted at Hawassa governmental hospitals between April and May 2023, involving 422 adult outpatients living with diabetes. The study aimed to evaluate their comorbidities, nutritional status, and associated factors. The required data were collected using structured and semi-structured questionnaires. Bivariate and multivariate logistic regression analyses were conducted using SPSS version 25.0. Undernutrition and concordant comorbidities were prevalent in the study population, occurring at rates of 15.2% and 57.8%, respectively. Additionally, 18.5% of participants were classified as overweight and obese with a BMI greater than 25 kg/m2. Three significant predictors of undernutrition among adult outpatients living with diabetes were identified: alcohol intake (P < 0.05), comorbidities (P < 0.01), and educational status (P < 0.05). Concordant comorbidity was notably common in these patients. It is recommended that the healthcare system consider comorbid conditions when managing diabetes. A longitudinal study is suggested to provide stronger evidence on these findings.

Under-nutrition and its associated factors among adult second-line antiretroviral treatment users in Northern Ethiopia

BACKGROUND

Despite advancements in Human Immunodeficiency Virus (HIV) treatment and care, undernutrition remains a significant concern, accelerating disease progression and risk of Acquired Immune Deficiency Syndrome (AIDS)-related deaths. The nutritional status of second-line antiretroviral treatment (SLART) users in Ethiopia has not been thoroughly investigated. So, this study aimed to assess the nutritional status of HIV/AIDS patients who were on SLART and its associated factors in Northern Ethiopia.

METHODS

A retrospective cross-sectional study was conducted on 366 HIV-infected adults who had been on SLART for at least six months in northern Ethiopia. Clients who had documented Weight and height at six months of therapy were included. Data was entered and cleaned by using EpiDATA version 4.6.0.2 and statistical analysis was done by STATA version 17. Multiple imputation method was applied to manage variables having up to 25% missing values by using R-Version 3.6.2 software. Binary logistic regression was used with P < 0.05 as a significant predictor in the final analysis. Data was collected from February 01 to April 30, 2021.

RESULTS

The magnitude of undernutrition among adults who were on SLART in the study area was 38.52% (95%CI: 33.65-43.64). Those populations also had a baseline undernutrition status of 39.1% (95%CI: 34.11-44.15) during their transition to SLART. The risk of being malnourished at six months of SLART initiation was fifteen times higher among those who were undernourished at SLART start (AOR:15.099, 95%CI: 8.532, 26.720) reflecting the high burden of the problem in the advanced courses of HIV/AIDS treatment and care.

CONCLUSIONS

The proportion of undernutrition among SLART users in Northern Ethiopia is high. During HIV therapy, a client's overall nutritional health is predicted by their prior undernutrition condition. This highlights the need for comprehensive nutritional assessment, counseling, and monitoring of the nutritional status of SLART users in the area with emphasis on an early identification of possible barriers to the improvement of such conditions. Promoting the consumption of nutrient-dense local foods and appropriate food preparation methods in addition to nutritional support are vital in this setting.

On the Relationship Between Frailty, Nutritional Status, Depression and Quality of Life Among Older People

BACKGROUND

Frailty is a multidimensional geriatric syndrome associated with physical, psychological and social changes. There is a paucity of research on frailty in Sub-Saharan African (SSA) countries, especially Ethiopia.

OBJECTIVES

To assess the initial correlations among frailty, nutritional status, depression and QOL (quality of life) in a group of older people in Ethiopia who are later enrolled in a study examining the effects of a nurse-led community intervention on frailty and related health outcomes.

METHODS

Data from 68 community-dwelling individuals 60 years of age, or over, were collected. Frailty was measured using the Amharic version of the Tilburg Frailty Indicator. The statistical analysis included Spearman's rank correlation coefficient for degrees of association, Mann-Whitney U-test for variables with two categories and Kruskal-Wallis for variables with three or more categories.

RESULTS

The mean frailty score for participants was 7.3 (±1.9). Participants with higher frailty scores had lower nutritional status (rs = -0.46, p < 0.01). There was a statistically significant relationship (positive) between frailty scores and depression (rs = 0.39, p < 0.01). Depressed (Md = 9, n = 23) and non-depressed frail older people (Md = 7, n = 45) showed a significant difference in their overall frailty score, U = 330.50, z = -2.49, p = 0.01, r = 0.30. There was an inverse significant association between the level of frailty across different domains in the QOL: physical (rs = -0.44, p < 0.01), psychological (rs = -0.45, p < 0.01), social relations (rs = -0.29, p < 0.05) and environmental (rs = -0.47, p < 0.01).

CONCLUSION

The findings from this study were consistent with those from across middle-income and high-income countries.

IMPLICATIONS FOR PRACTICE

This research indicates that older people living in communities who are identified as frail often suffer from a poor nutritional status, depression and reduced QOL. It suggests that healthcare professionals in Sub-Saharan countries would benefit from recognising the frailty in this population, and developing interventions aimed at enhancing nutrition, mental health and overall well-being.

Nutritional status of hospitalized elderly patients in Ethiopia: a cross-sectional study of an important yet neglected problem in clinical practice

Background

Malnutrition is a common geriatric syndrome affecting approximately half of the older population with a more pronounced occurrence rate in those hospitalized. It affects the physiology, and results in poor humanistic and clinical outcomes. In Africa, particularly in Ethiopia, albeit multiple studies are available on malnutrition in non-hospitalized older population, similar studies in inpatient settings are scarce. Therefore, this study was conducted with the intention to quantify the prevalence of malnutrition in older patients on inpatient admission and determine its associated factors.

Methods

A total of 157 older inpatients aged 60 years and above were included in the present study. The data collection format was developed after an in-depth review of relevant literatures. The full Mini-Nutritional Assessment (MNA) tool was employed to assess the nutritional status on admission. Data completeness was checked thoroughly. Descriptive statistics and logistic regression analysis were conducted using STATA 15.0. The area under the receiver operating characteristic curve (ROC), Hosmer-Lemeshow test, and classification table were computed to evaluate the final model goodness-of-fit.

Results

Of the total study subjects, 81% were malnourished (MNA score <17) and 17% were at risk for malnutrition (MNA score of 17.5-23.5). However, upon review of the patients' medical charts, malnutrition diagnosis was recorded in only two patients. Rural residence (AOR = 2.823, 95%CI: 1.088, 7.324), self-reported financial dependence for expenses (AOR = 4.733, 95%CI: 1.011, 22.162), and partial dependence in functional autonomy on admission (AOR = 3.689, 95%CI: 1.190, 11.433) significantly increased the risk of malnutrition. The area under the ROC curve (0.754) and the Hosmer-Lemeshow test (p = 0.7564) indicated that the final model reasonably fits the data. The model`s sensitivity is 96.85%.

Conclusion

In the present study, an alarmingly high prevalence of malnutrition was identified older inpatients. The problem went undiagnosed in a similar percentage of patients. Several available literatures indicate the presence of an association between nutritional status and patient outcomes, thus strict nutritional screening at inpatient admission and intervention are recommended with special emphasis for those from rural areas, with financial dependence, and with functional impairment on admission.

Behavioral model-guided nutritional counseling could improve the dietary practice and nutritional status of elders in Ethiopia: a quasi-experimental study

BACKGROUND

Physiological, pathological, and socioeconomic changes occurring in older people negatively influence food intake, utilization, nutritional status, and health. These problems are deeply rooted in low socio-economic settings and could partly be addressed through systematic behavioral change approaches. Hence, this study was to evaluate the effect of behavioral model-guided nutritional counseling on the dietary intake and nutritional status of elders.

METHODS

A one-armed pre- and post-test quasi-experimental design was conducted on 293 community-dwelling older adults aged above 60 years from January to May 2022. A health education tool was developed and validated using health beliefs and the theory of behavioral change. The sessions were delivered by trained nurses through home-to-home visits every week lasting 45-60 min for up to two months. Data on nutritional knowledge, dietary intake, and body weight were captured using standardized questionnaires and measurements. The primary outcome was captured using the validated mini-nutritional assessment (MNA) tool and classified accordingly. The data was analyzed using Stata software, where it is presented in tables, graphs, and summary statistics. A paired t-test and the p-value were used to identify statistically significant effects of the intervention.

RESULTS

A total of 263 elders were involved in the experiment, and modeled nutritional counseling significantly improved the knowledge score from 7.58 (± 1.05) to 11.6 (± 1.37) (P < 0.001) at the pre- and post-intervention periods. A significant improvement has been shown in the consumption of dairy products, fruits, and animal-source foods and, importantly, in the mean dietary diversity score (p < 0.001). As a result, the burden of malnutrition was significantly lower in the post-intervention period (9.6%: 7.9-11.3) compared to baseline (12.5%: 11.4-13.8). There is a significant increase in the mini-nutrition assessment score (MD = 0.30; p = 0.007). The mean body weight and the body mass index did not change significantly after the intervention (p > 0.05).

CONCLUSION

Targeted behavioral model-guided nutritional counseling could help promote perception, diversify dietary consumption, and reduce the risk of undernutrition among elders. Particular attention to older people with the use of participant-centered nutritional behavioral change interventions coupled with livelihood support could help reduce undernutrition among older people.

TRIAL REGISTRATION

Clinical Trial Registration-URL: www.

CLINICALTRIALS

gov , identifier number: NCT04746664, first released 10/02/2021.

Level of malnutrition and associated factors among community-dwelling rural older adults in Fogera Zuriya district, Northwest Ethiopia

OBJECTIVES

Malnutrition is very common among older adults. In rural Ethiopia, around 25% of women and 34% of men ≥65 y of age are malnourished. However, the risk factors for malnutrition among older adults in rural areas are not well understood. The aim of this study was to assess the level of malnutrition and associated factors among community-dwelling rural older adults in Fogera Zuriya district, Northwest Ethiopia.

MATERIALS

This was a community-based, cross-sectional study among randomly selected (N = 634) adults ≥65 y of age in Fogera Zuriya rural district. Participants were selected using a multistage sampling technique. A pretested full Mini-Nutritional Assessment (MNA) tool was used to classify as malnourished (MNA score <17), at risk for malnutrition (MNA score 17-23.5), or otherwise normal. A validated Geriatric Depression Scale form (15 items) was used to assess depression. Ordinal logistic regression was employed to identify factors of malnutrition and the PLUM procedure was used to produce an odds ratio (OR). P < 0.05 was considered statistically significant with the dependent variable. Both crude and adjusted ORs (COR and AOR, respectively) with a corresponding 95% confidence interval were computed.

RESULTS

This study included 634 older adults. According to the results of the study, the risk for malnutrition was 383 (60%), and being malnourished was 166 (268%). The following factors were significantly associated with the risk for malnutrition and malnutrition: • Age ≥85 y (AOR, 3.47; 95% CI, 1.270-9.465); • Skipping two meals daily (AOR, 6.36; 95% CI, 2.11-19.16); • Skipping 1 meal a day (AOR, 3.05; 95% CI, 1.82-5.12); • Having a poor appetite (AOR, 6.2; 95% CI, 2.50-15.36); • Being depressed (AOR, 4.04; 95% CI, 2.37-6.89); • Low physical activity (AOR, 3.81; 95% CI, 1.50-9.72); • Family size of three of less members (AOR, 1.9; 95% CI, 1.14-3.24); and • Low dietary diversity score (AOR, 1.91; 95% CI, 1.11-3.31) CONCLUSIONS: In this study, the prevalence of malnourished (26%) was almost higher than the national average in Ethiopia (21%). Older age, skipping a meal, poor appetite, depression, low physical activity, and low dietary diversity score were factors significantly associated with the risk for malnutrition and malnutrition. Along with this, improving diet and exercise should be a top priority. Maintaining continuing psychological support, social support, and a balanced family size within the community should be additional interventions.