Health Workers’ Practices, Barriers, and Facilitators to Nutrition Risk Assessment in Critically Ill Adults at Mbarara Regional Referral Hospital: A Sequential Explanatory Mixed-Methods Study

Background Malnutrition in critically ill adults accelerates catabolism, heightens infection risk, prolongs ICU stays, and increases mortality. Early Nutrition Risk Assessment (NRA) within 24–48 hours of admission is globally recommended to reduce these complications, yet its uptake remains low in resource-limited settings. The study assessed health workers’ practices, barriers and facilitators of nutrition risk assessment of critically ill adult patients at Mbarara Regional Referral Hospital (MRRH), Uganda. Methods We employed a sequential explanatory mixed-methods design. Quantitatively, using systematic random sampling, 322 ICU and Emergency Unit records (July 2023–July 2024) were reviewed using a 23-item Nutrition Risk Assessment documentation review checklist. Qualitatively, 16 purposively sampled health workers underwent in-depth interviews. Quantitative data were analyzed with STATA 17, and qualitative data underwent thematic analysis. Results Only 7.1% of records showed comprehensive NRA documentation; 92.9% were incomplete. Biochemical markers (hemoglobin, MCV) were recorded in 82%, whereas anthropometry and clinical exams were documented in < 2%. Key barriers included absence of standardized protocols, inadequate equipment (e.g., bed scales, portable weighing scales), high workload, and patient financial constraints. The primary facilitator was health workers’ self-directed nutrition knowledge. Conclusion NRA practices at MRRH are critically suboptimal. Implementation of context-adapted guidelines/ protocols, prioritization of nutrition risk assessment in daily rounds and the provision of adequate resources are required.