A Snapshot of the Experience of Dietitians during the COVID-19 Crisis in Five Arab Countries: Findings from a Regional Cross-Sectional Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Data Collection
2.2. Dietitians’ Eligibility
2.3. Study Instruments
2.4. Ethical Considerations
2.5. Data Analysis
3. Results
3.1. Demographic and Profession-Related Characteristics of Dietitians Working in Hospitals and Clinics in Arab Countries
3.2. Dietitians’ Practices and Duties in Hospitals and Clinics during the COVID-19 Pandemic in Arab Countries
3.3. Dietitians’ Practices in Providing Nutrition Care and Nutrition Support for COVID-19 Hospitalized Patients
3.4. Dietitians’ Experienced Challenges in Providing Nutrition Care for COVID-19 Patients in Arab Countries
4. Discussion
Study Limitations
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Country | Screening for Malnutrition | Assessing for Malnutrition | Prescribing of Nutritional Support | Formulation and Calculation Nutritional Support | Placing Feeding Tubes | Assessing of Residual Volume in Feeding Tube |
---|---|---|---|---|---|---|
Lebanon | Yes | Yes | No | Yes | No | Yes |
Saudi Arabia | No | Yes | No | Yes | No | No |
Kuwait | No | Yes | Yes | Yes | No | No |
Oman | Yes | Yes | No | Yes | No | No |
Tunisia | Yes | Yes | Yes | Yes | Yes | Yes |
Overall (N = 903) | Females (n = 750) | Males (n = 153) | p-Value | ||||
---|---|---|---|---|---|---|---|
N | % | N | % | N | % | ||
Country of residence | <0.001 ** | ||||||
Kuwait | 181 | 20.0 | 167 | 22.3 | 13 | 8.7 | |
Lebanon | 180 | 20.0 | 178 | 23.8 | 2 | 1.2 | |
Oman | 181 | 20.0 | 147 | 19.6 | 34 | 22.1 | |
Saudi Arabia | 181 | 20.0 | 120 | 16.1 | 60 | 39.4 | |
Tunisia | 180 | 20.0 | 136 | 18.2 | 44 | 28.6 | |
Age | 0.02 * | ||||||
20–30 years old | 441 | 48.8 | 380 | 50.7 | 61 | 39.8 | |
>30 years old | 462 | 51.2 | 370 | 49.3 | 92 | 60.2 | |
Years of dietetic practice experience | 0.001 * | ||||||
≤5 years | 463 | 51.3 | 394 | 52.4 | 70 | 45.6 | |
More than 5 years | 440 | 48.7 | 356 | 47.6 | 83 | 54.3 | |
Highest education level | 0.01 * | ||||||
Bachelor’s | 641 | 71.0 | 521 | 69.5 | 119 | 77.9 | |
Diploma | 196 | 21.7 | 64 | 8.5 | 2 | 1.6 | |
Master’s/Doctor of Philosophy (Ph.D.) | 66 | 7.3 | 165 | 21.9 | 31 | 20.5 | |
Current employment status | <0.001 ** | ||||||
Full-time (≥40 h/week) | 706 | 78.2 | 569 | 75.9 | 137 | 89.7 | |
Part-time (<40 h/week) | 197 | 21.8 | 181 | 24.1 | 16 | 10.3 | |
Practice Facility | <0.001 | ||||||
Military hospitals | 22 | 2.5 | 21 | 2.8 | 1 | 0.8 | |
Ministry of Health (MOH) public hospitals | 545 | 60.4 | 427 | 57.0 | 118 | 77.2 | |
University teaching hospitals | 41 | 4.5 | 39 | 5.2 | 2 | 1.1 | |
Specialized hospitals | 11 | 1.2 | 7 | 0.9 | 4 | 2.3 | |
National guard hospitals | 3 | 0.3 | 3 | 0.4 | 0 | 0.0 | |
Medical Cities | 13 | 1.5 | 9 | 1.2 | 4 | 2.5 | |
Private hospitals | 134 | 14.9 | 127 | 17.0 | 7 | 4.6 | |
Private clinics | 80 | 8.8 | 76 | 10.1 | 4 | 2.3 | |
Others (dispensary, polyclinic) | 53 | 5.9 | 40 | 5.3 | 14 | 8.9 |
Overall (N = 903) | Kuwait (n = 181) | Lebanon (n = 180) | Oman (n = 181) | Saudi Arabia (n = 181) | Tunisia (n = 180) | p-Value | |
---|---|---|---|---|---|---|---|
N (%) | n (%) | n (%) | n (%) | n (%) | n (%) | ||
Dietitians’ workload | <0.001 ** | ||||||
Similar to the pre-pandemic period | 537 (59.5) | 83 (46.0) | 59 (32.5) | 164 (90.7) | 72 (39.8) | 159 (88.3) | |
Increased, compared to the pre-pandemic period | 123 (13.6) | 64 (35.3) | 15 (8.5) | 13 (7.3) | 29 (16.1) | 1 (0.6) | |
Decreased, compared to the pre-pandemic period | 243 (26.9) | 34 (18.7) | 106 (59.0) | 4 (2.0) | 80 (44.1) | 20 (11.0) | |
Dietitians’ case load | <0.001 ** | ||||||
Similar to the pre-pandemic period | 403 (44.7) | 41 (22.7) | 41 (22.5) | 155 (86.0) | 41 (22.6) | 125 (69.6) | |
Increased, compared to the pre-pandemic period | 179 (19.8) | 70 (38.7) | 12 (6.5) | 16 (8.7) | 80 (44.1) | 2 (1.0) | |
Decreased, compared to the pre-pandemic period | 218 (24.2) | 42 (23.3) | 87 (48.5) | 6 (3.3) | 45 (24.7) | 38 (21.0) | |
The respondent is not aware | 103 (11.4) | 28 (15.3) | 41 (22.5) | 4 (2.0)1 | 16 (8.6) | 5 (8.4) | |
Being given additional tasks that are deemed outside of the typical responsibilities | <0.001 ** | ||||||
No | 734 (81.3) | 92 (50.7) | 166 (92.0) | 170 (94.0) | 128 (71.0) | 178 (98.7) | |
Yes | 169 (18.7) | 89 (49.3) | 14 (8.0) | 11 (6.0) | 52 (29.0) | 2 (1.3) | |
The type of the given task | |||||||
Screening for COVID-19 | 50 (5.5) | 20 (11.3) | 5 (3.0) | 6 (3.3) | 17 (9.7) | 1 (0.3) | <0.001 ** |
Taking and recording patients’ temperatures | 28 (3.1) | 2 (1.3) | 5 (3.0) | 7 (4.0) | 12 (6.5) | 1 (0.6) | 0.006 * |
Started to cover out-patients’ clinics, in addition to providing care to in-patients | 32 (3.6) | 11 (6.0) | 1 (0.5) | 1 (0.7) | 19 (10.8) | 0 (0.0) | <0.001 ** |
Covering other wards outside of the usual routine | 60 (6.7) | 35 (19.3) | 2 (1.0) | 0 (0.0) | 23 (12.9) | 0 (0.0) | <0.001 ** |
Inserting nasogastric feeding tubes | 13 (1.4) | 6 (3.3) | 1 (0.5) | 0 (0.0) | 6 (3.2) | 0 (0.0) | <0.001 ** |
Performing food service tasks which not typically do (i.e., Tray line check) | 76 (8.4) | 58 (32.0) | 4 (2.0) | 1 (0.7) | 14 (7.5) | 0 (0.0) | <0.001 ** |
Other tasks (e.g., education sessions, preparing supplement formulas for patients) | 20 (2.2) | 5 (2.7) | 3 (1.5) | 0 (0.0) | 12 (6.5) | 1 (0.3) | <0.001 ** |
The mode of nutrition care provision to patients has changed at the facility | <0.001 ** | ||||||
No | 480 (53.1) | 57 (31.3) | 75 (42.0) | 152 (84.0) | 43 (23.7) | 153 (84.8) | |
Yes | 423 (46.9) | 124 (68.7) | 105 (58.0) | 29 (16.0) | 138 (76.3) | 27 (15.2) | |
The current mode of nutrition care provision for patients is (n = 423; among those who reported a change) | <0.001 ** | ||||||
Remote nutrition consults (for all patients) | 120 (20.0) | 44 (36.0) | 35 (33.7) | 0 (0.0) | 39 (28.1) | 1 (2.1) | |
Remote nutrition consults (only for suspected or confirmed COVID-19 patients) | 303 (33.5) | 79 (64.0) | 70 (66.3) | 29 (100.0) | 100 (71.9) | 26 (97.9) |
Overall (N = 903) | Kuwait (n = 181) | Lebanon (n = 180) | Oman (n = 181) | Saudi Arabia (n = 181) | Tunisia (n = 180) | p-Value | |
---|---|---|---|---|---|---|---|
N (%) | n (%) | n (%) | n (%) | n (%) | n (%) | ||
Providing nutrition care to patients who confirmed or suspected to have COVID-19 | <0.001 ** | ||||||
No | 371 (41.1) | 53 (29.3) | 120 (66.5) | 5 (2.7) | 39 (21.5) | 155 (85.8) | |
Yes | 532 (58.9) | 128 (70.7) | 60 (33.5) | 176 (97.3) | 142 (78.5) | 26 (14.2) | |
Providing in-person nutrition care for COVID-19 patients (n = 532; among those reported providing care for COVID-19 patients) | |||||||
No | 352 (66.1) | 46 (35.8) | 51 (81.4) | 131 (75.3) | 101 (71.2) | 23 (90.9) | <0.001 ** |
Yes | 180 (33.9) | 82 (64.2) | 12 (18.6) | 43 (24.7) | 41 (28.8) | 2 (9.1) | |
Having access to personal protective equipment (PPE) in your facility | <0.001 ** | ||||||
No | 18 (2.0) | 8 (4.7) | 4 (2.0) | 0 (0.0) | 6 (3.2) | 0 (0.0) | |
Yes, most of the time | 333 (36.9) | 57 (31.3) | 28 (15.5) | 10 (5.5) | 66 (36.6) | 10 (5.5) | |
Yes, occasionally | 104 (11.5) | 55 (30.7) | 9 (5.0) | 14 (7.8) | 25 (14.0) | 14 (7.8) | |
Not applicable | 448 (49.7) | 60 (33.3) | 140 (77.5) | 156 (89.7) | 83 (46.2) | 156 (86.7) | |
Malnutrition screening for suspected or confirmed COVID-19 patients | <0.001 ** | ||||||
No | 557 (61.7) | 116 (64.0) | 155 (86.0) | 10 (5.3) | 99 (54.8) | 178 (98.7) | |
Yes | 346 (38.3) | 65 (36.0) | 25 (14.0) | 171 (94.7) | 82 (45.2) | 2 (1.3) | |
Malnutrition screening tool | |||||||
MUST (a) | 272 (30.2) | 53 (29.3) | 8 (4.5) | 171 (94.7) | 39 (21.5) | 1 (0.6) | <0.001 ** |
MNA (b) | 32 (3.6) | 6 (3.3) | 11 (6.0) | 2 (1.3) | 12 (6.5) | 1 (0.6) | 0.003 * |
NRS2002 (c) | 66 (7.3) | 4 (2.0) | 9 (5.0) | 24 (13.3) | 29 (16.1) | 0 (0.0) | <0.001 ** |
mNUTRIC (d) | 24 (2.7) | 10 (5.3) | 2 (1.0) | 7 (4.0) | 6 (3.2) | 0 (0.0) | 0.01 * |
The resources/guidelines relied on when providing nutrition care to COVID-19 patients | |||||||
Country-specific Ministry of Health recommendations | 289 (32.0) | 71 (39.3) | 39 (21.5) | 51 (28.0) | 107 (59.1) | 22 (12.3) | <0.001 ** |
Country-specific Food and Drug Authority recommendations | 67 (7.4) | 8 (4.7) | 15 (8.5) | 4 (2.0) | 33 (18.3) | 7 (3.9) | <0.001 ** |
Country-specific Clinical Nutrition Society resources | 38 (4.2) | 5 (2.7) | 4 (2.0) | 14 (8.0) | 16 (8.6) | 0 (0.0) | <0.001 ** |
International Clinical Nutrition Society resources | 105 (11.6) | 13 (7.3) | 9 (5.0) | 65 (36.0) | 17 (9.7) | 0 (0.0) | <0.001 ** |
WHO recommendations | 354 (39.2) | 75 (41.3) | 38 (21.0) | 176 (97.3) | 43 (23.7) | 23 (12.9) | <0.001 ** |
ESPEN (e) guidelines | 335 (37.1) | 49 (27.3) | 18 (10.0) | 175 (96.7) | 93 (51.6) | 0 (0.0) | <0.001 ** |
ASPEN (f) guidelines | 357 (39.5) | 69 (38.0) | 16 (9.0) | 176 (97.3) | 95 (52.7) | 1 (0.3) | <0.001 ** |
Books | 53 (5.9) | 17 (9.3) | 5 (3.0) | 16 (8.7) | 16 (8.6) | 0 (0.0) | <0.001 ** |
Webinars | 129 (14.2) | 41 (22.7) | 13 (7.0) | 34 (18.7) | 39 (21.5) | 3 (1.6) | <0.001 ** |
Others | 8 (8.8) | 4 (2.0) | 1 (0.5) | 0 (0.0) | 4 (2.2) | 0 (0.0) | <0.001 ** |
The nutrition intervention provided for COVID-19 patients (n = 640) | |||||||
Oral nutrition prescription | 151 (16.7) | 49 (27.3) | 14 (7.5) | 8 (4.7) | 80 (44.1) | 0 (0.0) | <0.001 ** |
Nutrition support (EN or PN) | 154 (17.0) | 52 (28.7) | 9 (5.0) | 10 (5.3) | 74 (40.9) | 0 (0.0) | <0.001 ** |
Nutrition supplement therapy | 129 (14.2) | 47 (26.0) | 6 (3.3) | 1 (0.6) | 66 (36.6) | 9 (5.0) | <0.001 ** |
Nutrition education | 115 (12.7) | 47 (26.0) | 10 (5.5) | 10 (5.3) | 45 (24.7) | 1 (0.6) | <0.001 ** |
Nutrition counselling | 91 (10.1) | 27 (14.7) | 12 (6.5) | 11 (6.0) | 41 (22.6) | 1 (0.0) | <0.001 ** |
Most often provided nutrition support for mechanically ventilated COVID-19 patients | 0.01 * | ||||||
Generally, nutrition support is not provided | 15 (1.6) | 0 (0.0) | 5 (3.0) | 1 (0.7) | 8 (4.3) | 0 (0.0) | |
Enteral nutrition | 136 (15.0) | 46 (25.3) | 10 (5.5) | 2 (1.3) | 78 (43.0) | 0 (0.0) | |
Parenteral nutrition | 18 (2.0) | 7(4.0) | 4 (2.0) | 1 (0.7) | 6 (3.2) | 1 (0.3) | |
Not sure | 734 (81.3) | 128 (70.7) | 161 (89.5) | 176 (97.3) | 89 (49.5) | 180 (99.7) | |
Method used to estimate the energy requirements for COVID-19 patients (n = 272) | |||||||
Harris-Benedict equation | 56 (6.2) | 17 (9.3) | 12 (6.5) | 5 (2.7) | 21 (11.8) | 1 (0.6) | <0.001 ** |
Mifflin-St. Jeor equation | 39 (4.3) | 18 (10.0) | 9 (5.0) | 1 (0.7) | 10 (5.4) | 1 (0.3) | <0.001 ** |
Ireton-Jones equation | 13 (1.4) | 2 (1.3) | 3 (1.5) | 0 (0.0) | 8 (4.3) | 0 (0.0) | 0.01 * |
WHO/FAO/UNU | 27 (2.9) | 12 (6.7) | 5 (3.0) | 4 (2.0) | 6 (3.2) | 0 (0.0) | 0.006 * |
Schofield equation | 9 (1.0) | 2 (1.3) | 3 (1.5) | 2 (1.3) | 2 (1.1) | 0 (0.0) | 0.610 |
TEE (total energy expenditure) | 23 (2.5) | 13 (7.3) | 3 (1.5) | 1 (0.7) | 6 (3.2) | 0 (0.0) | <0.001 ** |
The “Quick” method | 97 (10.7) | 22 (12.0) | 7 (4.0) | 2 (1.3) | 64 (35.5) | 1 (0.6) | <0.001 ** |
Others | 14 (1.5) | 2 (1.3) | 4 (2.0) | 0 (0.0) | 8 (4.3) | 1 (0.3) | |
Prescribing immune enhancer feeds or intravenous vitamins and trace elements for critically ill COVID-19 patients | 0.001 ** | ||||||
No | 850 (94.2) | 175 (96.7) | 178 (99.0) | 181 (100.0) | 171 (94.6) | 180 (99.7) | |
Yes | 53 (5.8) | 6 (3.3) | 2 (1.0) | 0 (0.0) | 10 (5.4) | 1 (0.3) | |
Most common nutrition diagnosis among COVID-19 patients | |||||||
Inadequate energy intake | 127 (14.0) | 53 (29.3) | 9 (5.0) | 2 (1.3) | 82 (34.4) | 0 (0.0) | <0.001 ** |
Inadequate oral intake | 120 (13.3) | 34 (18.7) | 9 (5.0) | 7 (4.0) | 70 (38.7) | 0 (0.0) | <0.001 ** |
Inadequate protein intake | 89 (9.9) | 47 (26.0) | 6 (3.5) | 0 (0.0) | 10 (5.4) | 1(0.3) | <0.001 ** |
Inadequate fluid intake | 79 (8.7) | 36 (20.0) | 5 (2.5) | 1 (0.7) | 37 (20.4) | 0 (0.0) | <0.001 ** |
Malnutrition (based on screening and assessment) | 58 (6.5) | 25 (14.0) | 7 (4.0) | 0 (0.0) | 25 (14.0) | 1 (0.3) | <0.001 ** |
Swallowing difficulties | 54 (6.0) | 18 (10.0) | 6 (3.5) | 10 (5.3) | 19 (10.8) | 1 (0.3) | <0.001 ** |
Altered gastro-intestinal function | 52 (5.8) | 16 (8.7) | 4 (2.0) | 0 (0.0) | 33 (18.3) | 0 (0.0) | <0.001 ** |
Unintended weight loss | 51 (5.7) | 27 (14.7) | 7 (4.0) | 0 (0.0) | 17 (9.7) | 0 (0.0) | <0.001 ** |
Overweight/obesity | 44 (4.8) | 14 (8.0) | 1 (0.5) | 1 (0.7) | 27 (15.1) | 0 (0.0) | <0.001 ** |
Feeding difficulties | 43 (4.8) | 16 (8.7) | 1 (0.5) | 1 (0.7) | 23 (12.9) | 0 (0.0) | <0.001 ** |
Inadequate enteral nutrition infusion | 43 (4.7) | 19 (10.7) | 1 (0.5) | 1 (0.7) | 21 (11.8) | 0 (0.0) | <0.001 ** |
Abnormal nutrition-related laboratory values | 37 (4.1) | 11 (6.0) | 3 (1.5) | 0 (0.0) | 23 (12.9) | 0 (0.0) | <0.001 ** |
Inadequate vitamin intake | 37 (4.1) | 22 (12.0) | 3 (1.5) | 0 (0.0) | 12 (6.5) | 1 (0.6) | <0.001 ** |
Inadequate mineral intake | 32 (3.5) | 20 (11.3) | 1 (0.5) | 0 (0.0) | 10 (5.4) | 1 (0.3) | <0.001 ** |
Excessive fluid intake | 28 (3.1) | 17 (9.3) | 2 (1.0) | 0 (0.0) | 10 (5.4) | 0 (0.0) | <0.001 ** |
Limited adherence to nutrition prescriptions | 28 (3.1) | 10 (5.3) | 3 (1.5) | 0 (0.0) | 16 (8.6) | 0 (0.0) | <0.001 ** |
Inadequate parenteral nutrition infusion | 19 (2.1) | 10 (5.3) | 0 (0.0) | 0 (0.0) | 10 (5.4) | 0 (0.0) | <0.001 ** |
Excessive fat intake | 18 (2.0) | 8 (4.7) | 3 (1.5) | 1 (0.7) | 6 (3.2) | 0 (0.0) | <0.001 ** |
Excessive carbohydrate intake | 13 (1.4) | 6 (3.3) | 2 (1.0) | 1 (0.7) | 4 (2.2) | 0 (0.0) | <0.001 ** |
The facility provides adequate resources for the nutritional management of COVID-19 patients | |||||||
No | 36 (4.0) | 4 (2.0) | 2 (1.0) | 0 (0.0) | 31 (17.2) | 0 (0.0) | <0.001 ** |
Yes | 866 (96.0) | 177 (98.0) | 178 (99.0) | 181 (100.0) | 150 (82.8) | 180 (100.0) |
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Bookari, K.; Arrish, J.; Zaher, S.; Alkhalaf, M.; Alharbi, M.; Alkhattaf, N.; Harb, Z.; Al Hinai, E.; Alanqodi, N.; Almajed, S.; et al. A Snapshot of the Experience of Dietitians during the COVID-19 Crisis in Five Arab Countries: Findings from a Regional Cross-Sectional Study. Nutrients 2022, 14, 4904. https://doi.org/10.3390/nu14224904
Bookari K, Arrish J, Zaher S, Alkhalaf M, Alharbi M, Alkhattaf N, Harb Z, Al Hinai E, Alanqodi N, Almajed S, et al. A Snapshot of the Experience of Dietitians during the COVID-19 Crisis in Five Arab Countries: Findings from a Regional Cross-Sectional Study. Nutrients. 2022; 14(22):4904. https://doi.org/10.3390/nu14224904
Chicago/Turabian StyleBookari, Khlood, Jamila Arrish, Sara Zaher, Majid Alkhalaf, Mudi Alharbi, Najla Alkhattaf, Ziad Harb, Eiman Al Hinai, Nahla Alanqodi, Sana Almajed, and et al. 2022. "A Snapshot of the Experience of Dietitians during the COVID-19 Crisis in Five Arab Countries: Findings from a Regional Cross-Sectional Study" Nutrients 14, no. 22: 4904. https://doi.org/10.3390/nu14224904