THE SIGALAGALA NATIONAL POLYTECHNIC

A REPORT ON FIELD ATTACHMENT AT MOMBASA

HOSPITAL

PERIOD : 5TH SEP TO 30TH Dec 2022

INSTITUTION : THE SIGALAGALA NATIONAL

POLYTECHNIC

DEPARTMENT : APPLIED SCIENCE

PRESENTED BY : FLORENCE BOLO

PROGRAMME : DIPLOMA IN NUTRITION AND

DIETETICS MANAGEMENT

ADM NO : DND21S/4955

NAME OF THE SUPERVISOR: ROSEBELLE OKETCH

Table of Contents

Table of Contents...........................................................................................................................2
Declaration.....................................................................................................................................5
Acknowledgement..........................................................................................................................6
Abstract..........................................................................................................................................7
Introduction....................................................................................................................................8
Historical Background....................................................................................................................8
Vision.............................................................................................................................................8
Mission...........................................................................................................................................8
Policy..............................................................................................................................................8
Mandate..........................................................................................................................................9
Organizational Structure................................................................................................................9
Acronyms/Abbreviations.............................................................................................................10
CHAPTER ONE..........................................................................................................................12
1.1 METHODS AND MATERIALS USED DURING ATTACHMENT..................................12
1.1.1 METHODS..........................................................................................................................12
1. Nutrition Counseling................................................................................................................12
2. Use of Demonstration...............................................................................................................12
3. Nutrition Education..................................................................................................................13
4. Health Talks.............................................................................................................................13
5. Nutritional Assessment............................................................................................................13
1.2 MATERIALS.........................................................................................................................13
2.1.1 Female Medical Ward.........................................................................................................17
CHAPTER THREE......................................................................................................................25
3.1 Paedriatic Ward/NBU (Ward 4).............................................................................................25
3.1.1 Objectives............................................................................................................................25
3.1.2 My roles and activities........................................................................................................25
3.1.3 Experience Gained..............................................................................................................26
3.1.3.1 Phase 1 Treatment............................................................................................................26
3.1.3.2 Dehydration in Malnutrition.............................................................................................27
3.1.3.3 The Transition Phase........................................................................................................27
CHAPTER FOUR........................................................................................................................29
4.1 Surgical Ward (Ward 5).........................................................................................................29
4.1.1 Roles and Activities............................................................................................................29
4.1.2.1 Comprehensive Nutrition Care for Patients in Surgical Ward.........................................29
CHAPTER FIVE..........................................................................................................................31
5.1 Mother and Child Health Care...............................................................................................31
5.1.1 Objectives............................................................................................................................32
5.1.2 My Roles and Activities......................................................................................................32
5.1.3 Experience Gained..............................................................................................................32
CHAPTER SIX............................................................................................................................34
6.1 Maternity Ward (Ward 1).......................................................................................................34
6.1.1 Objectives............................................................................................................................34
6.1.2 Positioning and Attachment................................................................................................35
6.1.3 Proper Hygiene and Sanitation............................................................................................36
6.1.4 Exclusive Breastfeeding......................................................................................................36
6.1.5 Experience Gained..............................................................................................................36
6.1.5.1 Post-Partum and Ante-Partum Rooms.............................................................................36
CHAPTER SEVEN......................................................................................................................37
7.1 Kitchen...................................................................................................................................37
Conclusion/Challenges.................................................................................................................38
Recommendation..........................................................................................................................38
Recommendations To The Hospital.............................................................................................38
References....................................................................................................................................38
Appendix 1...................................................................................................................................40
Declaration

I have declared that this work is my own original and has not been done by anyone else or
presented by any institution.

Name : FLORENCE BOLO

Date : 30TH NOVEMBER 2022

Signature : ………………………………….

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Organization Background

I carried out my attachment at the Mombasa Hospital on 5th September to 30th November 2022.
The aim of the attachment was to familiarize and put in practice theoretical part I learnt in class.
In the process, I managed to carry out the task given under the objectives.

The Hospital is owned by the Mombasa Hospital Association, an association of members. The
Association is a company Limited by Guarantee and not having a share capital. It is registered
under the Companies Act, Chapter 486 of the Laws of Kenya.
The Hospital is not for a profit and is managed on behalf of the Association by a Management
Board comprising seven elected and four nominated members.
The Board appoints a Medical Advisory Committee to advise the Board of Management on all
matters pertaining to the efficient management of the clinical services of the Hospital. 

Vision

To be the leading private health care service provider and referral center on the East African
Coast

Mission

To provide high quality preventive and curative health care at primary, secondary and selected
tertiary levels

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Organizational Structure
Medical Superintendent

Medical and Health Administrative Hospital Matron

Paramedical Services Officer

Radiography, Nutrition Non-Medical Services Nursing and Outpatient

Services Services

Supplies Medical Account and Welfare Personal

Officer Technology Billing Services Services and
Engineering Registry

Nutrition Officer In- Nutrition Supervisors Nutrition Interns Nutrition Attachees

Charge

Mombasa Hospital Organogram

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DESCRIPTION OF DAILY ACTIVITIES

METHODS AND MATERIALS USED DURING ATTACHMENT

METHODS

1. Nutrition Counseling

Here, the client is greatly involved in making right nutrition choices as the nutritionists act
majorly to guide him/her into making sound nutrition decisions. The patient is asked questions
to stimulate an interactive session as the nutritionist make notes on relevant issues and finally
leading the clients into making final decision. However, the sole decision-making lies with the
client being counseled.

The application of nutrition counseling was in all wards and outpatient units including the
comprehensive care clinic. Nutrition counseling on its own has proved to be an effective tool in
assessing client’s level of knowledge in nutrition.

2. Use of Demonstration

Use of demonstrations was applied extensively in the maternity wards (Ward 1 & 4). Here, the
following demonstrations were carried out:

- Positioning and attachment of the infants during breastfeeding.

- Family planning methods.
- Proper hygiene and sanitation.

This method allowed the mothers and listeners to engage in the session actively hence
increasing the knowledge retention.

This method has a demerit in that it takes a lot of time in the preparation and demonstration as
well.

3. Nutrition Education

Nutrition education is a process whereby clients/patients are enlightened on nutrition to acquire

skills, attitude and knowledge for the sole purpose of developing healthy dietary habits and
choices.

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This method was advantageous in the sense that it can be used to disseminate nutritional
knowledge in a hospital setting for both inpatient and outpatients as well as in a community
setting.

4. Health Talks
Consists of nutrition education to a number of clients, which involves choosing a topic on
relevant areas based on the audience majorly health talks were given in the mother and child
health clinic.
5. Nutritional Assessment
Anthropometric and clinical methods of assessment were majorly used in determining the
nutritional status of clients/patients.
Anthropometric measurements used included MUAC, weight, height and length.
Clinical assessment methods included checking for presence of edema, oral thrush in the mouth,
baggy pants and temperature.

1.2 MATERIALS

1.2.1 Anthropometric Equipment

1. Mid Upper Arm Circumference (MUAC) Tapes

These tapes were used in the nutrition assessment of patients in pediatric wards, maternity
wards, mother and child clinic, outpatient nutrition clinic and the chest clinic.

Children below six months and patients whose weight and height could not be easily obtained
e.g. bedridden patients also had their MUAC reading taken to determine their nutrition status.

MUAC is a tool used to measure the level of wasting in patients with readings being taken on
the middle of the upper left arm using a special tape.

2. Real Objects (Food Samples and Food Models)

Use the actual objects in giving nutrition counseling or education. Most of the real objects that
were being used were food samples. This helped to make the learners identify with the foods
being referred to and also made sessions more interesting. Example of food samples included;
beans, wheat, flour, groundnuts, peas, French beans and omena. These materials were majorly
wards, mother and child clinic and the nutrition outpatient department.

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3. Growth Charts for Children

The growth charts were used in the pediatric wards and mother child health clinics. These charts
were found in the mother-child booklets. From the charts, by measuring the weight of the child,
one could determine the level of nutrition in terms of standards deviations. With +24D meaning
the child is overweight and -25D denoting underweight.

4. Weighing Scales

These were used in the wards to determine the weight and nutritional status of the patient,
calculate the amount of protein and calorie intake and level of edema. Weight also showed the
level of wasting in the patient. Example of weighing scale that was used include the tarred scale.

5. BMI for age Reference Chart for Children 5-17 years

This chart was used in determining the level of nutrition in the above named age bracket. Most
of its application was in the comprehensive care clinic.

6. Flip Charts

Flip charts were used to show BMI for age charts, Age for weight charts and other nutrition
information. The child had step to step counseling information for HIV/AIDs patients.

7. Pamphlets

These are nutrition messages printed in small pocket size print publications. Use of pamphlets
was among the diabetic patients where they were issued with the pamphlets as a reminder of
what was discussed with them pertaining nutrition. The pamphlets were however in limited
number and at times, we were forced to write nutrition messages on sheets of paper. However,
their use was very effective in passing of the information.

8. Stadiometers

These were used to measure the height of patients and determine the level of stunting. The data
dot from here (height) was also used as input in calculating the BMI of patients and clients.

9. Recording Tools

Nutrition care plan forms – were specialized forms for writing the nutrition care process that a
patient had been put on.

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 a) Feeding regime forms – were used in the pediatric wards to indicate the types of feeds,
nutrition status and assessment details of the patient and the amount of the feed being
administered.
b) Pen.
c) Tallying sheets.
d) Register books for clients – SEP, OTP MOH 409, MOH 407A.
e) Growth monitoring graphs.
f) Clinic cards/books.
g) Tally books.
h) Patients’ medical files.

10. Nutrition Supplements

i. B-Immune – Given to those patients with compromised immunity like the RVD, TB and
cancer patients.
ii. Fresubin – Prescribed for patients with poor and low appetite which is also high in
proteins.
iii. Febrin – Prescribed for children/patients with poor appetite also high in protein.
iv. F-100 – Therapeutic milk given for the treatment of SAM in children below the age of
two years. It is given during the transition phase and phase two of treatment.
v. F-75 – Therapeutic feed given to children below the age of two years during the initial
phase for the treatment of SAM.
vi. Foundation Plus – Given to wasted RVD and TB patients together with RUTF
depending on severity of wasting to provide extra energy and calorie.
vii. Advantage Plus – Given to pregnant and lactating mothers to provide extra energy.
viii. Vitamin A – Given to specific target disease groups such as TB, measles patients, those
with eye problems and children of six months and between one year up to five years and
lactating mothers four weeks postpartum.
ix. Formula Milk e.g. Nan, Pre-Nan, cow’s milk especially to the abandoned children.

11. Working Materials

 Lab coat.
 Sterilizer.
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  Gloves.
 Syringes.

Duties of a Nutritionist

i. Nutrition assessments and counseling to patients.

ii. Nutritional reviews.
iii. Admissions and discharges to various nutrition programs.
iv. Monitoring and evaluating the level of nutrition programs.
v. Preparation and prescription of therapeutic feeds.
vi. Diet prescription and management, issuance of supplements.
vii. Management of disease conditions both inpatient and outpatient.
viii. Compiling daily and monthly reports
ix. Admission and discharges to various nutrition programs.
x. Documentations and office organization.

MEDICAL WARDS

This hosted varying conditions with most being; Diabetes mellitus, hypertension, peptic ulcers,
tuberculosis, pneumonia, cancer, anemia and HIV/AIDs. The activities done in this;

- Prepare a diet requisition sheet for patients.

- Nutrition assessments, counseling and reviews.
- Meal management and diet prescription.
- Reviewing their files daily to monitor their progress.

NUTRITION MANAGEMENT INTERVENTION

- Intake of calorie restricted diet to help in weight reduction.

- Take foods high in fiber to bind excess fats in the body.
- Avoid sugary foods to prevent elevation of sugars.
- Encourage physical activity to help in weight reduction.
- Take water at least 8 glasses per day.

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Food Exchange List

Patient - Z Carbohydrates - 234 g

Height - 1.62 m Proteins - 85 g

IBW - 71 Kgs Fate - 47 g

BM - 27.1 Kg/m2 Total Kcals - 1704 Kcals

Food Exchange List

List Serving Carbohydrates Proteins Fats Kcals

Milk 2 24 16 16
Fruits 4 60 - -
Vegetables 5 25 10 -
Starch 8 125 16 -
Meat 3 - 21 24
Fats 2 - - 10

Food Groups No. of Breakfast Snack Lunch Snack Supper

servings
Meat 3 1 - 1 - 1
Milk 2 1 - - 1 -
Vegetables 5 - - 3 - 2
Starch 8 2 2 1 2 1
Fruits 4 1 1 1 1 -
Fats 2 - - 1 - 1

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 PURPOSE OF ATTACHMENT

 Exposed me to the demand and challenges of a work place.

 I have gained of practical experience.
 I have gained work ethics
 Helped me acquire self-reliance skills.
 I have Developed work-based skills.
 Improve your cross-cultural communication skills.
 It gave me a competitive edge over graduate with no work experience.
 I have met with different people who may help me propel future career path.
During the antenatal clinics, the following are done; HIV screening for PMTCT, Iron and Folic
Acid supplementation. In postnatal clinics, the children underwent growth monitoring,
immunization, supplementation and other medical checklists.

Nutrition counseling is done to mothers during ANC visits on. They were encouraged to have
one extra meal, additional 500Kcals per day. Besides that, the pregnant mothers were sent to the
lab for urinalysis to check for the presence proteins in urine which would otherwise confirm risk
of preeclampsia. Presence of glucose or ketones would suggest presence of gestational diabetes.
My experience was on the counseling I did to the mothers with such conditions before they
were referred to the gynecological outpatient clinic (GOPC).

Pregnant women attended the monthly Focused Antenatal Care (FANC) visits which was aimed
at helping them maintain the normal progress of pregnancy through timely guidance and advice.

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CHALLENGES

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Recommendation

1. The hospital should launch a special nutrition awareness campaign that involves both the
staff and the public to tackle major injuries brought to the hospital such as high incidents
of malnutrition.
2. The frequency of the nutrition based Continuous Medical Education (CME) should be
increased to help students and the nutritionists have a better understanding of their
profession through sharing and getting updates from the same.
3. As a kind request to the nutritionists, they should spend more time with the students in
their workstations for close monitoring and assistance.
4. The hospital should work to ensure that therapeutic feeds are ordered on time especially
for the formula feeds to avoid shortages and consequently negative effect on the
patients.
5. The other hospital staff especially nurses should not overlook the work done by the
nutritionist since it plays a key role in improving the health of the patien

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