Knowledge, attitudes, and practices of registered dietitians and nutritionists regarding enteral and parenteral nutrition support in Ghana: a needs assessment study

Ruthfirst E A Ayande; Percival D Agordoh; Vanessa J Salino; Clarisa Webster-Ariyan; Lindsay Collier; Matilda Asante; Elena T Carbone

doi:10.3389/fnut.2023.1197610

Knowledge, attitudes, and practices of registered dietitians and nutritionists regarding enteral and parenteral nutrition support in Ghana: a needs assessment study

Front Nutr. 2023 Jun 29:10:1197610. doi: 10.3389/fnut.2023.1197610. eCollection 2023.

Authors

Ruthfirst E A Ayande^{1

2}, Percival D Agordoh^{3

4}, Vanessa J Salino¹, Clarisa Webster-Ariyan¹, Lindsay Collier¹, Matilda Asante⁴, Elena T Carbone²

Affiliations

¹ Department of Food and Nutrition, Yale-New Haven Hospital, New Haven, CT, United States.
² Department of Nutrition, University of Massachusetts Amherst, Amherst, MA, United States.
³ Department of Nutrition and Dietetics, University of Health and Allied Sciences, Ho, Ghana.
⁴ Department of Dietetics, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana.

Abstract

Background: There is a paucity of data on enteral and parenteral (EN and PN) nutrition support (NS) provided by nutrition and dietetic practitioners in adult acute care settings in Ghana. Furthermore, gray literature suggests that Ghanaian clinical nutrition professionals (CNPs) are seldom involved in advanced nutrition care teams.

Objectives: To assess the knowledge, attitudes, and practices of Ghanaian CNPs regarding EN and PN.

Methods: An online cross-sectional survey was administered to Ghanaian CNPs ahead of a professional development workshop on EN and PN Support. Participants were asked questions about initiation and timing of NS, and knowledge on availability of commercial formula. A 5-point Likert scale was used to assess self-efficacy in using EN and PN. To assess practical knowledge on EN and PN, participants were asked to identify whether EN or PN was indicated for seven short case scenarios. Open-ended questions were used to assess reasons for participant self-ratings.

Results: A total of 76 dietitians, nutritionists, students, and interns completed the survey. For EN, self-efficacy scores were lowest for the calculation of enteral goal rate, and goal volume (mean 3.20 ± 1.27), and writing of EN prescriptions (mean 3.07 ± 1.29). Self-efficacy scores for the formulation of alternative formulas in lieu of commercial formula were the highest (3.63 ± 1.36). For PN, self-efficacy scores for all domains were lower than 3, with the lowest scores observed for writing PN prescriptions (2.19 ± 1.14) and determining micronutrient additives (2.12 ± 1.04). We identified limited training and lack of practical exposure to NS, limited ability to effectively monitor tube feeds, and prohibitive cost and limited availability of EN and PN formula among the barriers impacting self-efficacy scores.

Conclusion: Given the vital role that CNPs play in the delivery of EN and PN, it is important to develop professional training programs especially focused on PN to bridge knowledge and practice gaps.

Keywords: Ghana; dietitian; enteral nutrition; nutrition professionals; nutrition support; parenteral nutrition.