Bridging the gap in patient care: utilization of nutrition risk screening tools in Kenyan referral hospitals

OBJECTIVE: Appropriate nutrition risk screening (NRS) with timely intervention improves malnutrition outcomes; however, limited knowledge and inconsistent use of validated tools hinder effective implementation. This study assessed knowledge and practice of NRS among nurses and nutritionists/dietitians in three Kenyan national referral hospitals-Kenyatta National Hospital (KNH), Moi Teaching and Referral Hospital (MTRH), and Kisii Teaching and Referral Hospital (KTRH), and established factors influencing implementation of validated nutrition screening tools. A mixed-methods cross-sectional design was used among 349 healthcare professionals through structured questionnaires, complemented by 18 key informant interviews and direct observations. Knowledge and practices related to commonly recommended nutritional screening tools (NRS-2002, MUST, and MST) were evaluated. RESULTS: A mixed-methods cross-sectional study was conducted among 349 healthcare professionals across Kenyatta National Hospital (KNH), Moi Teaching and Referral Hospital (MTRH), and Kisii Teaching and Referral Hospital (KTRH). Quantitative data were collected using structured questionnaires, complemented by 18 key informant interviews and direct clinical observations. Knowledge and practice of commonly used nutritional screening tools (NRS-2002, MUST, and MST) were assessed. The mean knowledge score was 5.04 ± 1.21 (maximum = 8), with MTRH scoring significantly higher than KNH and KTRH (p < 0.001). High knowledge levels were observed among 44% of respondents at MTRH compared with 14% at KNH and 4% at KTRH. The mean practice score was 6.32 ± 2.23 (maximum = 12), with significant variation across hospitals (p < 0.001). Knowledge level, education, and professional experience significantly predicted screening practice. Routine NRS was rarely conducted and relied mainly on anthropometric or clinical indicators rather than validated screening tools. Qualitative findings revealed barriers including limited training, lack of institutional policies, unclear professional responsibilities, and workforce shortages. Strengthening training, integrating standardized screening protocols, and prioritizing high-risk patient groups may improve NRS implementation in resource-constrained hospital settings. Future research should evaluate the effectiveness of targeted training interventions and institutional policy reforms in improving the implementation of nutrition risk screening in hospital settings.