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Disease related malnutrition in South Africa: A call to action

Despite its recognition as a condition in 1974, hospital related malnutrition continues to be largely unattended. In South Africa, studies show that the issue is wide-reaching – with potentially drastic results.


A number of studies attest to the prevalence of disease related malnutrition in South Africa. In 2016, a study by Moens, et al. surveyed 403 patients (with just over half of these – 52.9% - being male, and with an average age of 45.5) from the surgical, medical and gynaecological wards of a hospital – and revealed that, depending on the assessment tool used, as many as 62.9% of these patients presented with disease related malnutrition.


These findings are backed by a study conducted by Van Tonder et al which took place in 2018. Here, the researchers used a sample of 141 adult patients from three public hospitals, all in urban locations. Their findings were even more disconcerting than those of Moens, et al.: according to this study, the prevalence of malnutrition risk amongst patients stood at 72.3%, with 48.2% of these presenting as high risk.


Van Tonder’s team placed their research within the broader context of other studies available on the subject, noting that although such research is dated, and resulting data both scant and limited to three key regions within the country (Cape Town, Durban and Zululand), they have confirmed that malnutrition amongst patients may be as high as 15 and 82%.


Indeed, Moens, et al. notes that while the global incidence of disease related malnutrition stands at 15-76%, the high rate of poverty in South Africa places our patients at greater risk.


The statistics are alarming, particularly because of the implications for an already overburdened healthcare system. As Moens writes, “Hospital malnutrition is associated with increased cost of care, complications, increased length of stay, mortality and poor quality of life compared to well-nourished patients.”


Van Tonder’s team expands on this further, noting that in 2009, “the health and social care costs associated with malnutrition in the UK were estimated to amount to at least 13 pounds billion annually”. This is due to risks such as “delayed recovery and prolonged hospital stay, increased risk of morbidity and mortality, increased general practitioner visits, and a greater likelihood of admission to care homes or step-down facilities”. In some cases, patients with disease related malnutrition report a hospital stay around 4.5 days, or 43%, longer than well-nourished patients.


South Africa’s situation is exacerbated further still by the absence of routine nutritional screening, which would help to identify at-risk patients; as well as the fact that most nurses (in the wards covered by Van Tonder’s study) were insufficiently equipped, in terms of skills and knowledge, to conduct nutritional screening.


The message is clear: Without a well articulated strategy coordinated at national level, disease related malnutrition will continue to impact South African hospitals, with devastating effects. The country’s dietitians have a critical role to play here, advocating for awareness of this condition and lobbying for hospitals to take a more proactive stance, by providing nutritional supplements to at-risk patients even before malnutrition has been diagnosed, for instance. It is also vital that dietitians become more actively involved in the formulation of hospital menus, with a special focus on high protein, high energy foods.


With treatment of disease related malnutrition foundering for the past 25 years, the time has come to address this condition – and to uplift South African patients in the process.


References available on request.



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