REPUBLIC OF KENYA  
        
                    MINISTRY OF HEALTH 
        
        
        
        
                              
                              
         KENYA NATIONAL CLINICAL NUTRITION 
           AND DIETETICS REFERENCE MANUAL  
        
        
        
                     FIRST EDITION 
        
        
        
                     FEBRUARY 2010 
        
                                     
                                FOREWORD 
         The strategic  plan  for  the  Ministry  of  Medical  Services  underlines  medical  services  reform 
         agenda as a lead strategy in the realization of the sectoral objectives outlined in the NHSSPII and 
         Vision 2030. Central to this agenda is the need to strengthen health care service delivery focusing on 
         equitable  access,  quality  and  responsiveness,  efficiency  and  effectiveness.    Given  the  strong 
         association between malnutrition and increased risk of morbidity and mortality, hospitalization and 
         time taken for patient to recuperate and the reduction in the cost of health care, the importance of 
         nutrition  care  in  the  delivery  of  curative  and  rehabilitative  health  services  cannot  be 
         overemphasized.  Moreover, in line with the Kenya’s Essential Package for Health, the ministry’s 
         strategic  plan  identifies  the  need  for  nutrition  and  dietetic  services  as  well  as  provision  of 
         therapeutic and supplemental nutrition commodity for the management of malnourished patients as 
         a core area of focus. 
         Irrespective of the cause of morbidity, all inpatient and outpatient clients require nutrition care 
         services ranging from counseling and education to nutrition support therapies. The importance of 
         these interventions is exemplified by the observation that, clinical nutrition is a core component of 
         the national strategy on management of diabetes mellitus and accounts for up to 70% of the effort in 
         management and prevention of the disease complications.  In addition, the burden of infectious 
         diseases, particularly HIV/AIDS and attendant opportunistic infections double the need for clinical 
         nutrition care in our hospitals.  With the core function of the Ministry being to ensure availability of 
         essential medical care as needed, the Division of Clinical Nutrition and Dietetics has developed a 
         Clinical Nutrition and Dietetics Manual that aims at enhancing availability of nutrition services at all 
         levels.  The  roll  out  of  this  manual  is  one  of  the  key  steps  that  the  Ministry  is  taking  towards 
         advancing the quality of clinical service delivery in hospitals countrywide. It is intended to help 
         patients through improved care during hospitalization and recuperation at home. 
         Furthermore,  the  Ministry’s  strategic  plan  recommends  the  establishment  of  medicine  and 
         therapeutic  committees  in  all  health  facilities.  This  manual  will  assist  these  committees  in  the 
         integration  and  strengthening of nutrition services in a standardized manner. To fast track this 
         process,  facilities  may  find  it  useful  to  establish  facility  nutrition  support  team  to  advise  the 
         committee on in patient feeding and nutritional management of various diseases and conditions, 
         prescription of appropriate foods and nutraceuticals and drug-nutrient interactions among other 
         aspects.  These  teams  will  review  the  facility  standard  operating  procedures  and  recommend 
         strategies to ensure development towards attainment of international standards of nutrition service 
         delivery. In addition, this manual will address important gaps in existing curriculums for training 
         front line clinical staff trainees in nutrition support and therapy. The government fully appreciates 
         contributions and participation by partners and other stakeholders in preparing this manual and for 
         supporting ongoing nutrition care services in the country.  
          
         Hon. Prof. Peter Anyang' Nyong'o EGH, MP 
         Minister for Medical Services 
                            ACKNOWLEDGEMENT 
          
         The Kenya National Manual for Clinical Nutrition and Dietetics was developed under the 
         auspices of the Division of Clinical Nutrition and Dietetics.  Experts from several organizations 
         in Kenya carried out the preparation of the manual. The Drafting Committee' and members of 
         the Clinical Nutrition and Dietetics Working Group is gratefully acknowledged. Members of 
         the Working Group carried out synthesis and final drafting. 
          
         The  manual  development  process  received  technical  support  from  Dr  A  Muriithi  National 
         Professional Officer, Child and Adolescent Health and Nutrition WHO KCO.  Dr W Maina, 
         Head Department of Non Communicable Diseases provided technical input in sections on non 
         communicable  diseases.  In  addition,  the  following  institutions  participated  in  the  drafting 
         process; Department of Nutrition Kenyatta National Hospital, Department of Nutrition Moi 
         Teaching and Referral Hospital, Department of Nutrition and Dietetics Aga Khan University 
         Teaching Hospital, Nutrition unit NASCOP, Department of Human Nutrition and Dietetics of 
         Egerton  University,  Department  of  Foods,  Nutrition  and  Dietetics  of  Kenyatta  University, 
         Walter Reed South Rift Program and Capacity Kenya. Ministry of Medical Services, WHO 
         Kenya  Country  Office,  USAID  Nutrition  and  HIV  Program  (USAID|NHP)  through  the 
         Academy for Educational Development (AED) provided support for the manual development. 
         The Ministry of Medical Services sincerely thanks these partners for their support. 
          
         The invaluable support from the office of the Permanent Secretary Ministry of Medical Services 
         is greatly appreciated. The guidance and support provided by the Director of Medical Services, 
         Dr  F  Kimani  and  the  Head  Department  of  Medicine  Dr.  B.  Mogoa  is  also  gratefully 
         acknowledged. Last but not least, we wish to sincerely thank the entire editorial team and the 
         reviewers for their tireless effort and dedication towards the finalization of this manual. God 
         Bless you all.  
          
          
          
          
          
          
          
              Clinical Nutrition and Dietetics Working Group Members 
              R. Ngaruro    Chief Nutritionist, Division of Clinical Nutrition, Ministry of Medical Services 
              L. Mugambi  Senior  Nutrition  Officer,  Division  of  Clinical  Nutrition,  Ministry  of  Medical 
                            Services 
              B. Samburu    Senior  Nutrition  Officer,  Division  of  Clinical  Nutrition,  Ministry  of  Medical 
                            Services 
              S. Mbugua     Lecturer, Department of Human Nutrition and Dietetics, Egerton University 
              N. Munyao     Nutrition Department, Kenya Medical Training College, Karen 
              W. Nyamota  Lecturer, Department of Food, Nutrition and Dietetics, Kenyatta University  
              E. Mutemi     Nutrition Technical Adviser, Capacity Kenya  
              J. Kerubo     Nutrition Officer, Moi Teaching and Referral Hospital, Eldoret  
              W. Bor        Nutrition Program Officer, Walter Reed South Rift Program  
              E. Ndung’u    Senior  Nutrition  Officer,  Division  of  Clinical  Nutrition,  Ministry  of  Medical 
                            Services 
              T. Hongo      Senior  Nutrition  Officer,  Division  of  Clinical  Nutrition,  Ministry  of  Medical 
                            Services 
              F. Wambua     Senior  Nutrition  Officer,  Division  of  Clinical  Nutrition,  Ministry  of  Medical 
                            Services 
              P. Maina      Nutrition  Officer,  Embu  Provincial  General  Hospital,  Ministry  of  Medical 
                            Services 
              C. Ngina      Nutrition Officer, Mbagathi District Hospital, Ministry of Medical Services 
              Z. Muriuki    Senior Nutrition Officer, Division of Non Communicable Diseases, Ministry of 
                            Public Health and Sanitation 
              B. Gisemba    Head, Department of Nutrition, Kenya Medical Training College 
              L. Kiige      Senior  Nutrition  Officer,  Division  of  Clinical  Nutrition,  Ministry  of  Medical 
                            Services 
              M. Wachira    Nutrition Manager, NASCOP