NUTRITION-RELATED KNOWLEDGE AND ATTITUDE OF PRACTISING NIGERIAN MEDICAL DOCTORS TO NUTRITION COUNSELLING DURING THE COVID-19 PANDEMIC 2020

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O.F. Folasire^1,2, T. Ilori³, and J.K.A. Madaki⁴

1. Human Nutrition Department, College of Medicine, University of Ibadan, Nigeria.
2. Department of Family Medicine, University College Hospital, Ibadan, Nigeria.
3. Family Medicine Unit, Department of Community Medicine, University of Ibadan, Nigeria.
4. Department of Family Medicine, University of Jos, Nigeria/Jos University Teaching Hospital, Nigeria

Abstract

Background: Adequate nutrition is needed to enhance the immune system,
especially at the time of COVID-19 pandemic for disease prevention and treatment.

Objective: The study aimed to assess physicians’ knowledge to nutrition-related issues of COVID-19 infection and explore their attitudes to offering nutritional counselling to patients.

Method: This was a cross-sectional online study conducted among doctors in private and public institutions across the six (6) geo-political zones in Nigeria using the social media online platforms of the Nigerian Medical Association (NMA) from August 17 to September 26, 2020. A categorisation of the knowledge score into sufficient and insufficient was done using the mean (sd) knowledge score. The attitude score was categorised into positive and negative using the median (IQR) attitude score, and bivariate analysis was used to test for associations.

Results: Responses were gotten from a total of 176 doctors over six weeks of data collection. Majority 97(55.1%) were females, and 84 (47.7%) had practised between 11 and 20 years. Majority 95(54.0%) had insufficient knowledge, while 128(72.7%) of the respondents had a negative attitude to nutrition counselling of patients regarding COVID-19. Females had significantly better knowledge about nutritionrelated issues of COVID-19 (p=0.004). However, there was no significant difference in the respondents’ attitude based on professional cadre, gender, place of practice, and years of practice.

Conclusion: Respondents were deficient in the knowledge of common food items containing relevant nutrients essential for boosting immunity. Hence, there is a need to encourage physicians training in nutrition and nutritional counselling.

Keywords: COVID-19, Nutrition-knowledge, Attitude, Physicians, Nigeria

Introduction

The novel disease caused by a new strain of Coronavirus called Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2) popularly called COVID-19 was firstly discovered in Wuhan city, Hubei Province of China in December 2019.¹ Everyone is susceptible to the zoonotic infection; however, the body’s immune system is crucial in fighting the virus in the body. Hence, the elderly population and people living with some diseases that render them immunocompromised are more at risk with associated greater mortality than the younger healthy population. ² Clinical studies have shown that a healthy person’s immune system could fight the virus within days.² It was observed that there was a complete immune response across all cell types necessary for building the immune system to recover an infected patient. ³ From a nutritional standpoint, some foods can be eaten at the time of this virus outbreak that can help strengthen the immune system.⁴Given the side effects of COVID19 on the nutritional status of patients, it is not surprising that nutrition agencies around the world have published guidelines, consensus, opinions, guidelines and specific recommendations for COVID-19.⁵

Many patients with acute infection have inadequate nutrition and water-electrolyte imbalance because of the consequential loss of appetite, vomiting and diarrhoea. Therefore, the provision of adequate nutrition and proper rehydration is an essential part of care and prevention.⁶ Despite various international interventions, the management of COVID-19 remains supportive, strengthening the need for proper nutritional counselling.⁷ Hence, as we combat with COVID-19, it is crucial to make sure that the population’s dietary requirements are met and upheld, especially the most vulnerable group.⁸ Adequate nutrition can be vital in preventing an overinflammatory response to SARS-Cov-2 infection, preventing the disease from progressing to severe illness. The same approach is crucial in improving outcomes even during COVID-19.⁹ Several nutrients have been reported to be important in preventing and treating COVID-19.¹⁰ These include vitamins A, D, C and E, minerals such as zinc and selenium, fibre and essential fatty acids. This is because it stimulates action on the immune system. Thus, Improper diet and poor health can reduce resistance to infection and increase the severity of illness.¹¹

The World Health Organization (WHO) has emphasised the benefit of adequate nutrition to enhance the immune system, especially at the time of COVID-19 infection.¹² The European Society for Clinical Nutrition and Metabolism (ESPEN) gave concise guidance for the effective nutritional management of COVID-19 patients with ten statements aimed at the prevention and treatment of malnutrition in these patients.¹³

The ESPEN 2019 guidance consensus is for nutrition specialists to communicate the guidance to other health professionals to improve nutrition knowledge and overall care during COVID-19 era. Knowledge can have a significant impact on the perception of healthcare providers based on the experiences they have. It could delay optimising the nutrition of potential COVID-19 patients during a pandemic.¹⁴ However, the level of nutrition-related knowledge and attitudes of healthcare providers about COVID-19 is still not clear. Therefore, this study aimed to investigate the knowledge of doctors on nutrition-related issues of COVID-19 pandemic based on WHO recommendations and the ESPEN guidance 2019. We explored the attitude of doctors to offering nutritional counselling to patients seen during the COVID-19 pandemic using the health belief model.^{15, 16}