The role of good nutrition in improving clinical outcomes in hospitalized patients is well established. Many developing countries, including Malawi, are experiencing a double burden of malnutrition characterized by high prevalence of diseases related to both under- and overnutrition.1 Appropriate nutrition interventions for both conditions have been shown to be cost-effective and safe as well as reduce morbidity and mortality.2 3 Registered dietitians (RDs) are uniquely placed to provide appropriate nutrition interventions for prevention and treatment of chronic conditions owing to highly specialized skills in nutrition risk assessment and in formulating nutrition diagnoses and resultant care plans. Despite this, only a handful of African countries have established dietetics programs to fill this gap.4

The 2016 Malawi Demographic Health Survey shows an increasing prevalence of overweight and obesity among women from 10 percent in 1992 to 21 percent in 2015-16.5 The burden of chronic diseases associated with overweight and obesity is also rising at an alarming rate. One study reported a prevalence rate of 13.6 percent for diabetes mellitus, 4.4 percent for ischaemic heart disease, and 6.1 percent for strokes in the 30-69 population age groups in Malawi.1 These statistics highlight the need to strengthen both preventative and curative services for chronic conditions by building pre-service dietetic capacity in Malawi. To date, Malawian hospitals offer very limited clinical nutrition services owing to a lack of RDs.

It is with this background that the Lilongwe University of Agriculture and Natural Resources (LUANAR) partnered with the Feed the Future Innovation Lab for Nutrition and the College of Medicine at the University of Malawi to address the need to build pre-service dietetics capacity in Malawi and implement the first ever dietetic training program.

Program Description

The 18-month program consists of two semesters of rigorous, graduate-level coursework and 1,200 hours of practical application in local hospital settings where students work side-by-side with doctors and nurses at Kamuzu Central Hospital, Lilongwe and other training sites. The curriculum compiles both academic knowledge and practical skills and is designed to be as rigorous as equivalent programs elsewhere in the world but appropriate to local needs. The development of this program was generously supported by the United States Agency for International Development (USAID), with resources applied both from Washington, D.C. and from the USAID Mission in Malawi. The program was accredited by the Malawi Medical Council in 2016, and training of the first cohort of students began in April 2016. The students have successfully completed all the academic course work requirements and are now completing the eight-month long supervised medical practice in clinical nutrition.

Future Directions and Challenges

From its inception three and a half years ago, the LUANAR dietetics program has achieved many laudable milestones, fostering successful international, regional and in-country cooperation. For the first time in Malawi, dietetic services that are well adapted to local environments will be available. This effort has already received significant support from the government of Malawi, which has pledged to employ and retain dietitians within the structures of clinical services.

Future directions of the program include expanding into training for a master’s degree and establishing a national association that protects the interests of practicing dietitians, upholds standards and creates a platform for professional development activities. These will be key strategies in building local capacity to sustain the program and practice of dietetics.

Despite this positive first step in beginning to train dietitians locally, a critical shortage of RDs is likely to exist for many years to come, and the need to expand training must be emphasized.4 Equitable dietician distribution across the country has been cited as a challenge in other countries where there are few dietitians.4 This will likely also be a challenge in Malawi. Nevertheless, the accredited degree program means that graduates will be registered and welcomed as a new cadre in the local medical community. “We needed them yesterday,” said the Medical Council of Malawi as it gave LUANAR the go-ahead to begin the training.

Bibliography

[1] Bowie C. The burden of disease in Malawi. Malawi Med J. 2006; 18(3): 103-10.

[2] Elia, M., Normand, C., Norman, K., & Laviano, A. (2016). A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in the hospital setting. Clinical Nutrition, 30.

[3] Wylie-Rosett J, Delhanty L. An intergral role of the dietitian. J Am Diet Assoc. 2002; 102(8): 1065-8.

[4] Aryeetey R, Boateng L, Sackey D. State of Dietetics Practice in Ghana. Ghana Med J. 2014; 48(4): 219-24.

[5] Malawi Demographic and Health Survey 2015-2016. Zomba, Malawi and Rockville, Maryland, USA 2017.