Evaluation of a food access program on inpatient nutrition, recovery, cost of care, and health related quality of life in selected public hospitals in Rwanda

IntroductionBetter nutrition is a priority in African countries like Rwanda with high prevalence of undernutrition and growing rates of obesity. Since public health insurance does not cover meals, vulnerable hospital inpatients are at risk of deficiency. We assessed the nutrition, health, and wellbeing effects of providing meals through the Gemura hospital feeding program. MethodsWe tested outcomes of the intervention in four public hospitals on inpatients (n=794). The primary outcome of nutritional status as body mass index (BMI) was measured at admission and discharge. Additional data collected included daily food intake, length of stay (LOS), patient costs of care, HRQOL using the EuroQol EQ-5D-3L tool, and patient satisfaction based on the Net Promoter Score (NPS). ResultsMean weight in the Gemura group increased slightly (+0.6%), but the control group experienced a drop in average weight (-1.5%), with p=0.000. BMI distribution was improved generally in the Gemura group compared to controls, with the odds of being malnourished (BMI<18.5) at endline 9% greater in the control group (OR 1.09, p=0.000). LOS had weak association with study arm. Intervention group participants spent on average 40% less (10,985 RWF) on food and beverages than the control group (18,290 RWF) with high significance at p=0.000, while the control group spent less on total out of pocket costs of stay. Patient satisfaction and HRQOL scores were similar, except 40% less patients reported anxiety or depression in the Gemura group. ConclusionWhile further investigation is needed to assess recovery and patient-reported outcomes, improvements in nutrition, mental health, and out of pocket patient costs indicate the potential for the Gemura program to address nutrition gaps in hospital service delivery, to improve mental health, and to reduce economic barriers to care. What is already known on this topicMalnutrition has been associated with poor hospital outcomes, but few have studied access to nutritious food as a barrier, with scant evidence from intervention studies on inpatient food access in Sub-Saharan Africa, and none in Rwanda. What this study addsIn this study, we found that providing three nutritious meals a day to hospital inpatients in Rwanda improved food intake, reduced the odds of hospital malnutrition, reduced patient out-of-pocket costs, and had a positive effect on patient perceptions of their mental health compared to a control group. This is the first intervention study of its kind in Rwanda. How this study might affect research, practice or policyIn LMIC contexts of high malnutrition, these findings may help inform considerations of including hospital nutrition access programs in public health insurance schemes or other healthcare improvement initiatives.