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Impact of Nutrition Screening Programmes on Early Detection of Malnutrition among Older Adults in Nigeria

Abstract

Malnutrition is an important public health concern among older adults in Nigeria and may result from inadequate dietary intake, chronic diseases, reduced appetite, oral and dental problems, difficulty swallowing, functional limitations, social isolation, poverty, and limited access to nutritious foods. Malnutrition among older adults may increase susceptibility to infections, worsen existing health conditions, impair physical functioning, delay recovery from illness, and contribute to increased healthcare utilization and poor quality of life. However, malnutrition may remain undetected because nutritional assessment is not routinely conducted among older adults in many community and healthcare settings. Nutrition screening programmes provide an opportunity to identify older adults who are at nutritional risk and facilitate timely nutritional assessment, counselling, referral, and appropriate intervention. Against this background, this study investigates the impact of nutrition screening programmes on early detection of malnutrition among older adults in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and Health Systems Framework. The Health Belief Model explains how older adults' perceptions of susceptibility to malnutrition, perceived severity, perceived benefits of nutrition screening, perceived barriers, and cues to action may influence participation in screening programmes. The Social Ecological Model emphasizes the influence of individual, family, community, healthcare, socioeconomic, and environmental factors on nutritional status and access to nutrition screening services. The Health Systems Framework highlights the importance of service delivery, healthcare workforce, health information, essential equipment and technologies, financing, accessibility, referral systems, and continuity of care in effective nutrition screening programmes. Collectively, these theoretical perspectives provide a suitable framework for explaining how nutrition screening programmes may influence early detection of malnutrition among older adults in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise adults aged 60 years and above residing in selected urban, semi-urban, and rural communities and attending selected healthcare facilities across Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, local government areas, communities, healthcare facilities, and eligible older adults. Nutrition screening programmes will be assessed using indicators such as availability of routine nutrition screening, screening frequency, use of standardized nutrition screening tools, trained healthcare personnel, anthropometric assessment, dietary assessment, weight monitoring, body mass index assessment, assessment of recent unintentional weight loss, appetite assessment, functional and dietary risk assessment, documentation of screening results, referral procedures, and follow-up arrangements. Early detection of malnutrition will be assessed using indicators such as identification of individuals at nutritional risk, undernutrition, low body mass index, recent unintentional weight loss, inadequate dietary intake, reduced appetite, nutritional risk scores, newly identified malnutrition cases, referral for comprehensive nutritional assessment, and initiation of appropriate nutritional support where applicable. Data will be collected using structured questionnaires, standardized nutrition screening tools, anthropometric measurements, dietary assessment instruments, healthcare records, nutrition screening registers, referral records, and relevant programme documents. Descriptive statistics will be used to summarize participants' characteristics, nutritional status, screening coverage, risk factors, and patterns of malnutrition detection. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of nutrition screening programmes on early detection of malnutrition. Where a quasi-experimental design is adopted, malnutrition detection rates before and after implementation of the screening programme may be compared with those of a comparison group or setting to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that nutrition screening programmes have a significant positive impact on early detection of malnutrition among older adults in Nigeria. Older adults who participate in structured nutrition screening programmes are expected to have a greater likelihood of previously undetected nutritional problems being identified than those without access to routine screening. Regular screening may facilitate early identification of undernutrition, recent unintentional weight loss, inadequate dietary intake, reduced appetite, and other nutritional risk factors. Early detection may provide opportunities for comprehensive nutritional assessment, dietary counselling, treatment of underlying conditions, referral to dietitians or other healthcare professionals, and appropriate nutritional support. Community-based screening may also improve access to nutritional assessment among older adults who face geographical, financial, mobility, or healthcare-access barriers. However, inadequate screening equipment, shortage of trained nutrition and healthcare personnel, limited availability of standardized screening tools, poor referral and follow-up systems, financial constraints, and low awareness among older adults and caregivers may reduce the effectiveness of screening programmes. The study therefore expects accessible, standardized, regular, and well-integrated nutrition screening programmes to contribute significantly to improved early detection and management of malnutrition among older adults in Nigeria. The study is expected to contribute to the literature on nutrition screening, malnutrition detection, geriatric nutrition, older-adult health, nutritional assessment, community health, primary healthcare, preventive healthcare, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, primary healthcare centres, hospitals, nutritionists, dietitians, geriatric healthcare providers, community health workers, public health practitioners, development partners, and policymakers regarding strategies for improving nutritional health among older adults. The study will also provide evidence-based recommendations for integrating routine nutrition screening into healthcare and community-based services for older adults, improving access to standardized screening tools and trained personnel, strengthening referral and follow-up systems, increasing awareness among older adults and caregivers, and promoting early nutritional intervention to reduce the health consequences of malnutrition among older adults across Nigeria.

Keywords: Nutrition screening programmes, early detection, malnutrition, older adults, geriatric nutrition, nutritional assessment, community health, primary healthcare, nutrition screening, Nigeria, public health.