A FIELD ATTACHMENT REPORT UNDERTAKEN AT UASIN

GISHU COUNTY HOSPITAL

ZEPHANIAH KIPKORIR

19B/CND/0021

AN ATTACHMENT REPORT SUBMITTED TO KENYA MEDICAL

TRAINING COLLEGE IN PARTIAL FULFILLMENT FOR THE
CERTIFICATE IN NUTRITION AND DIETETICS

ELDORET TECHNICAL TRAINING INSTITUTE

PERIOD

FEBRUARY 2021 AND END APRIL 2021

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 DECLARATION

I, the undersigned, declare that this is my original work and has not been submitted to any

College or any institution of higher learning other than Kenya Medical Training College.

ZEPHANIAH KIPKORIR

19B/CND/0021

Signature: ______________________ Date: _________________________

This report has been presented for examination with my approval as the appointed supervisor.

Signature: _______________________ Date: _______________________

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 DEDICATION

I dedicate this report to family members for the support they gave me. May God Bless you all.

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 ACKNOWLEDGEMENT

I thank the Almighty Lord for giving me the Strength to undertake the attachment.

I do acknowledge at Uasin Gishu County Hospital for granting me an opportunity to be attached

to their institution in light of my industrial attachment.

My gratitude goes to my supervisor Mrs. Susan for support during my attachment

May the sovereign Lord and the only God bless you all.

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 TABLE OF CONTENT

DECLARATION.............................................................................................................................i
DEDICATION............................................................................................................................... iii
ACKNOWLEDGEMENT.............................................................................................................iv
TABLE OF CONTENT...................................................................................................................i
History of Uasin Gishu County Hospital.........................................................................................1
MCH................................................................................................................................................3
Nutrition intervention...................................................................................................................... 4
Documentation.................................................................................................................................5
MATERNITY..................................................................................................................................5
Activities done.................................................................................................................................5
Case study........................................................................................................................................5
Nutrition intervention...................................................................................................................... 6
Nutrition Monitoring and Evaluation.............................................................................................. 6
Documentation.................................................................................................................................7
CCC................................................................................................................................................. 7
NUTRITION CLINIC.....................................................................................................................9
ANC...............................................................................................................................................12
HOSPITAL KITCHEN................................................................................................................. 13
HOSPITAL MENU 2021.............................................................................................................13
COMMUNITY ACTIVITIES.......................................................................................................14
CHALLENGES AND THEIR SOLUTIONS............................................................................... 15
Challenges..................................................................................................................................... 15
Solutions........................................................................................................................................15

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Advice to Future Interns................................................................................................................15
CONCLUSIONS........................................................................................................................... 16
RECOMMENDATIONS...............................................................................................................16

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History of Uasin Gishu County Hospital

Uasin Gishu County Hospital is located along the Nairobi – Kampala highway and serves

approximately 300 patients a day. Due to the old nature of the structures in which the hospital

operates, most of the clinical services have been severely affected. Particularly, the laboratory is

completely dilapidated. The old roof affects services during rainy seasons as a result of the

leaking ceiling. Additionally, the hospital has only 2 functional toilets shared amongst patients,

staff and passers-by.

Uasin Gishu County lies in the mid-west of the Rift Valley and borders six counties, namely

Elgeyo Marakwet County to the east, Trans Nzoia to the north, Kericho to the south, Baringo to

the south- east, Nandi to the south-west and Kakamega to the west. The county covers a total

geographical area of 3,345.2 km2.

Uasin Gishu County is a highland plateau with altitudes falling gently from 2,700 meters above

sea level to about 1,500 meters above sea level. The average amount of rainfall in the county

ranges from 900 – 1200mm per annum. The county has two rainfall seasons: long rains (March

to August with the peak being May to August); and short rains (between September to

November). Temperature ranges from between 25 ºC–32ºC.

The topography is higher to the east and declines gently towards the western border. The county

is physiographically divided into three zones: the upper highlands, upper midlands and lower

highlands. These zones greatly influence land use patterns as they determine the climatic

conditions. The geology is dominated by tertiary volcanic rock with no known commercially

exploitable minerals.

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As per the 2019 census, Uasin Gishu had a total of 1,163,186 households. Most households in

Uasin Gishu County depend on food and cash crops, livestock, and employment for their

livelihoods. The major crops grown include maize, wheat, beans, potatoes, and horticultural

crops while livestock include dairy farming, beef cattle, goats, sheep, pigs, bee keeping,

rabbit farming and fish farming.

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 MCH

Who runs the MCH? It’s being ran by nurses, nutritionist’s clinical officers.

Activities done during 1 week

 weighing growth monitoring

 immunization

 given health task each day by a nutritionist

During my rotation in this department /was able to carry out the following as a nutritionist:

1. Nutrition assessment whereby I took anthropometric measurement like wt/MUAC

biochemical assessment where I checked lab result, clinical assessment checked the presence of

Odema and if were Anemic or not

2. Nutrition diagnosis for those who had nutrition related problems

3. Nutrition intervention for those not gaining weight as per recommended. I offered

counseling to the caregiver

4. Monitoring and evaluation whereby I gave them the return date \

5. Documentation.

No. of children attended to where 74 pregnant mothers.

Anaemic 31

Obese 12

Underweight 11

Normal 20

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 Case study

Patient:
5
x
Age: ⁄12

Gender – m

DX: common cold

Nutrition assessment: anthropometric - Previous Weight 11.0kg

- Current weight 11.0kg

- Length 8.5cm

- MUAC 12cm.

Nutrition diagnosis: poor weight gain related to inadequate breastfeeding as evidenced

by consisted weight record observed poor breast feeding skill of the mother.

Nutrition intervention

- Encourage the mother to breastfeed the baby after every 1 hour.

- Encourage the mother to breastfeed the baby on one breast at least 30 minutes before

switching to the next breast.

- Educate the mother on good attachment and positioning

- Sensitize on good hygiene and sanitization

- Nutrition monitoring and evolution.

- I gave to come off after one month

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Documentation

I documented in the nutrition book.

MATERNITY

Who runs the maternity?

It’s being ran by a collaboration of nurses, nutritionist, clinical officers, and public health.

Activities done

 Weighing weights

 Education on good nutrition to the mother

 Education on good attachment and positioning

 Counseling on importance of exclusive breast feeding

 Sensitization on good hygiene and sanitization

 Advice on importance of immunization vaccines.

 Monitored on their hospital food intakes

Total number of mothers I managed to attend to during my one week rotation was 18.

Only two were anaemic and I counseled them on increased intake of iron rich on foods.

Case study
Patient: X

Age: One day old

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 Gender: Female.

Nutrition assessment: A-birth weight of 2.3

B-not done

C-not sucking well, sleepy

D-low frequency of breastfeeding

Nutrition diagnosis: inadequate breast milk intake related to short breastfeeding duration as

evidenced by clinical assessment whereby the baby was too sleepy.

Nutrition intervention

Advice the mother to breastfeed the baby after every one hour

Encourage the mother to breastfeed the baby on one breast at least 30 minutes before switching

to the next breast

Advised the mother to increase her fluid intake which should be warm

Advised the mother to increase here food intake

Encouraged the mother to increase her fruits and vegetable intake

Nutrition Monitoring and Evaluation

I gave a return date after one month

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Documentation
Then did documentation patients details in the nutrition book

Normal Anaemic HIV DM Underweight Obese overweight

8-34 18 0 3 7 6

patients

9-25 10 0 0 8 7

patients

10–23 12 0 4 5 10 24.5

patients

11- 20 7 0 1 0 11 2 7

patients

12–15 8 0 0 0 5 2

patients

Total 55 0 8 20 39 28 12

117

CCC
Who runs the CCC?
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It is ran by a collaboration of nurses, nutritionists, clinical officers, and social workers.

Activities done included:

- Nutrition assessment

- Issuing of ARV’s, PEP, PREP.

- HIV Testing

- Follow Up

- Viral load testing

- Counseling

Total No. of patients counseled were 107

Nutrition support: I offered were nutrition counseling only since there were no supplements for

those who were severely undernourished we referred them to a nearby hospital.

Case study

Patient: x

Age: 40

Dx: Reactive

Nutrition Assessment: Anthropometric: Height – 165, Weight 45 KG, BMI – 16.5kg/m2

Clinical Assessment: Prominent ribs, looks thin, emaciated muscles

Dietary Assessment: Diet history, 24 Hour recall, Food Frequency questionnaire

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 Nutrition Diagnosis: Inadequate food intake related to insufficient household food

security as evidenced by low BMI of 16.5 kg/m2 and a thin look with prominent ribs

and emaciated.

Nutrition Interventions

- Recommended a small frequent meals

- Recommended on intake of energy and nutrient dense foods

- Recommended on snacking healthy and nutritious foods

- Encouraged on intake of variety of foods in a meal

- Advised on intake of water at least 8 glasses a day

- Recommended on increased intake of fruits and vegetables to boost immunity

- Advised on drug adherence

- Advised on safe sex practice

- Encouraged on physical exercises to keep fit

- Sensitized on good hygiene

Nutrition Monitoring and Evaluation: I gave TCA after 1 month

NUTRITION CLINIC
Activities done

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-Nutritional assessment.

a. Anthropometric assessment whereby we weight and calculate BMI.

b. Biochemical assessment documents the details from the lab results.

c. Clinical assessment whereby observed the physical and symptoms

d. Dietary assessment whereby I used food history, food frequency questionnaire and 24 hr

recall.

In this department the patients when we review their nutrition related problem include

1. Hypertensive patients

2. Diabetic patient

3. Anemic patient

4. Beverley acute malnourished.

5. Moderately acute malnourished

6. PUD Patients

7. Patients with pregnancy eating disorders

Nutrition support offered

1. Nutrition supplements e.g.; FBF, RUSF,RUTF, Vitamin A, Zn + ORS

2. Nutrition counseling.

3. Deworm patients

Case study

Patient: x

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 Age: 35

Gender: female.

Dx: PUD

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Nutrition assessment: A-WT 67 kg Height 57CM. BMI 27kg/m

B- Hpylori+ve

C- Stomach discomfort, irritable

D- Food history, food frequency questionnaire, 24 hours recalls.

Nutrition diagnosis: esophageal reflux related to excessive intake of acidic foods as evidenced

by biochemical assessment - hpylori+ve

Clinical assessment - abdominal pains

Nutrition Intervention

1. Recommended on reduced intake o acidic rich foods.

2. Recommended on reduced intake of spicy foods

3. Encouraged on intake of water instead of milk as a first aid

4. Advised on reduced intake of food while lying down

5. Recommended on thorough washing of fruits and vegetables

6. Advised on taking foods at warm temperature instead of eating cold food

Nutrition monitoring and evaluation: TCA, 1 month

Documentation : I documented in the nutrition book

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 ANC

Who runs the ANC- it runs by a collaboration of nurses and nutritionist.

Activities done

- weight weighing, MUAC measuring

- Nutrition counseling

- Nutrition supplementation of folic supp, and /FASS.

- Physical examination

- Documentation

Total number of pregnant mothers I attended to was 197.

84 mothers had normal nutrition status.

10 mothers had low hemoglobin level. Below 11g/dl

3 mothers had pregnancy eating disorders.

Case study

Patient: x

Age: 20

DX: Anaemic

Nutrition assessment: A-wt MUAC

127
B-Hb, 9.7g/dl. Temp 37oC B.P - ⁄75

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 C-pale eyes palm and tongue

D- Food history, food frequency questionnaire, 24 hours recalls.

Nutrition diagnosis: inadequate blood haemoglobin levels related to insufficient intake of iron

rich foods as evident by Hb level of 9.7g/dl and paleness of eyes, palm & tongue.

Nutrition intervention

1. Recommended on increase intake of iron rich foods such as vegetables and fruits

2. Recommended on increase intake of iron enhancer like vitamin C rich food

3. Encourage on reduced intake of iron inhibitors tannins in tea, phytates in some legumes and

oxalates in vegetables like spinach

4. Recommended on increase water intake at least 8 glass per day

Nutrition monitoring and evolution: I gave a return date after one month.

HOSPITAL KITCHEN
 The hygiene is good but should be improved particularly the drainage system

 There were 3 health talks in a week and were given by the nutritionist in charge

HOSPITAL MENU 2021

TimeMondayTuesdayWednesda Thursday Friday SaturdaySunday
y

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 Breakf Porridge Porridge Porridge Porridge Porridge Porridge Porridge
ast
8-8.30
Snack Mixed tea Mixed tea Mixed tea Mixed tea Mixed Mixed tea Mixed tea
10 served served served with served with tea served with served
o’clock with with bread/ bread/ served bread/ with
bread/ bread/ boiled egg boiled egg with boiled egg bread/
boiled egg boiled egg bread/ boiled egg
boiled
egg
Lunch Ugali Steamed Steamed Ugali Ugali Steamed Ugali
12.30- served rice Rice served served with served rice served served
1.30 with served with ndegu/ steamed with with beans/ with
steamed with Cabbage & kale steamed cabbage & steamed
kale beans/ fruit /cabbage kale fruit kale
/cabbage cabbage& and beef /cabbage /cabbage
and beef fruit &fruit and beef and beef
&fruit & fruit & fruit
Super Steamed Ugali Ugali Steamed Steamed Ugali Steamed
5- Rice served served with rice served Rice served with Rice
5.30p served with steamed with beans/ served steamed served
m with steamed kale cabbage with kale with
ndegu/ kale /cabbage ndegu/ /cabbage ndegu/
cabbage /cabbage and beef cabbage and beef Cabbage.
and beef

NB

Serve hot chocolate to clients at night.

Prepared by nutritionist:

1. Rosemary Birgen

2. Vincent Birech

3. Moses Koima

COMMUNITY ACTIVITIES
 Not involved in any

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CHALLENGES AND THEIR SOLUTIONS

Challenges
a) The time period for attachment is too short for one to learn all about the field of

specialization. As a result an attaché learns the basics in that particular area leaving out the

details.

b) Lack of full exposure since some materials/information is considered confidential and

therefore cannot be assessed by students on attachment and thus limits the student’s knowledge

of the procedures and activities in an organization

c) Insufficient working space

Solutions
a) Depending on the hospital, the policy on attachment duration should be flexible to allow for

extension, thus sufficient time to learn extensively and exhaustively.

b) In addition, there should be stipulations that guide attachés on what is expected of them and

the scope that they should cover.

c) Create more space for conducive working environment.

Advice to Future Interns

a) Interns should take their training seriously and undertake the internships with all their

strength. They should also be willing to go the extra mile so as to gain the necessary experience

in their areas of specialization.

b) It’s during internships that students are able to cultivate good relationships with their

potential employers necessary when they are done with their education. It is therefore

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 advisable for students to conduct themselves professionally all through their internship

period. Discipline is a major factor in the job market.

CONCLUSIONS
Attachment is a vital program for any student undertaking degree or a diploma program for it

enlightens the student on the work place and it exposes the student to the workplace and the

student is able to learn a lot from the area of attachment which is not taught in class, apply what

is taught in class and relate what is taught in class with the situation in the work place.

It is in this connection that the Uasin Gishu County Hospital provided the ample atmosphere for

my attachment, being attached in all the hospital’s departments, I was able to learn a lot and I

was prepared on what to expect in the workplace. I also learnt different skills in my area of

specialization. In conclusion I would state that the aim of the attachment was met and I was able

to achieve a greater percentage of the curriculum objectives.

RECOMMENDATIONS
In my opinion I feel that this Industrial attachment has been successful. I have been able to learn

first-hand the experiences of the work environment and to know the key areas of nutrition and

dietetics. Therefore I have come to appreciate the information that I have been able to acquire in

the academic field and applicable in the practical field.

Actually after being attached with Uasin Gishu County Hospital I do recommend the following

should be done to the interns students so as to improve the smoothness of attachment program.

(i) Attachés should be involved in community activities

(ii) Assessment of the students on attachment should be done in time to avoid situations

of accessing students in the last days before the end of the attachment period.

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(iii) University should assist the entire students look for places to carry out their attachment

since at times it’s hard for the students themselves to locate and to be absorbed in any institution

while undertaking their internship attachment as the university requirement.

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