Paving the way to detect adult malnourished patients in resource-limited settings : the first step to the right to nutritional care

Abstract

Hospital malnutrition, particularly disease-related malnutrition (DRM), is a significant public health concern associated with increased morbidity, mortality and costs. The recent Global Leadership Initiative on Malnutrition (GLIM) proposed a framework to globally standardise the diagnosis of adult malnutrition (undernutrition), allowing comparison of malnutrition prevalence across clinical and geographical settings and over time. Despite substantial global progress in using screening and diagnostic tools to identify malnourished patients, some countries and institutions lag behind, particularly in relation to malnutrition screening. This is especially of concern in low- and middle-income countries, including South Africa, where socioeconomic factors can exacerbate the occurrence of DRM. From a human rights perspective, the lack of malnutrition screening and diagnosis followed by appropriate nutritional support denies patients their fundamental right to access adequate food, nutritional care and health. This opinion paper highlights the magnitude of DRM and addresses current challenges in identifying DRM within resource-limited healthcare settings, specifically in the South African public health sector. Framing malnutrition as a human rights and ethical issue, it underscores the urgent need for timely and equitable nutritional care and proposes strategies to improve identification practices. Challenges identified comprise inadequate resources and institutional factors. Collaboration between key stakeholders, including the South African National Department of Health (including representatives from the National Health Insurance), policy-makers, medical aids, researchers and professional societies is needed to identify the most feasible malnutrition screening and diagnostic tools for constrained settings, together with a widespread coordinated implementation strategy. Prioritising nutrition as part of the holistic management of all patients will help safeguard against DRM and the associated adverse effects.