1.

0 INTRODUCTION
1.1 INTRODUCTION AND BACKGROUND
Kericho district Hospital is in Kericho County and situated in Kericho town along Nakuru-
Kisumu Highway and boarders Nakuru, Nandi, Bomet, Kisumu and Kisumu Counties.
The hospital started as a prisoners of war camp for the first world war before being converted
into a hospital and was called the native hospital in 1932. The native hospital had both in-patient
and out-patient services. It was named Kericho District Hospital after independence, with a
children ward, laboratory and administration block already in place.
Expansions of the hospital has been done in phases below:
● 1975 – New old patient, X-ray and labour ward were constructed by the Kenya
Government.
● 1986 – All other wards, kitchen, stores, theatre and mortuary.
● 2004 – A new MCH block was constructed by Elizabeth Glazer Foundation.
● 2005 – Incinerator by Walter Reeds.
● 2009 – Casualty block was constructed by Jica.
● 2011 – A new Administration block, Special Clinics and Comprehensive Care Centre
was constructed by Pep Far.
1.2 VISION
To have an efficient and high quality health care system that is accessible, equitable and
affordable to every Kenyan.
1.3 MISSION
To promote and participate in provision of integrated and high quality, promoter, preventive,
curative and rehabilitative health care services to all Kenyans.
1.4 MANDATE
To formulate policies, set standards, provide health services, create an enabling environment and
regulate the provision of health services.
1.5 CORE VALUES
Customer focus.
Highly motivated, trained and committed staff
Efficient and quality service delivery
Professionalism and team work.
Transparency and accountability.

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CHAPTER TWO
2.0 OBJECTIVES DURING FIELD ATTACHMENT
2.1 OVERALL OBJECTIVES
To familiarize myself with the hospital environment, the roles and functions of each
department in achieving the goals and objectives of the hospital.

2.2 SPECIFIC OBJECTIVES

⮚ To gain adequate practical, knowledge and skills in a work place environment.
⮚ To appreciate the relationship between the theories learnt in class and practical work in
the field.
⮚ To develop desirable work, ethics and attitudes maintaining good nutritional status of
patient with different conditions
⮚ To be punctual, effective and efficient in my work in the hospital environment.

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CHAPTER THREE
3.0 THE METHODS AND MATERIALS USED DURING MY ATTACHMENT PERIOD
3.1 METHODS USED
NUTRITION CARE PROCESS
I. Nutrition process
This is where by I was able to gather the patient’s details by taking their weight, height, MUAC
for pregnant mothers and children above six months, calculate the BMI for adults and Z-scores
for children. I check on clinical observations whether the patient is pallar, wasted or has oedema,
or prominent ribs, or brittle hair. I also check on the biochemical assessment that is H.b, R.B.S,
F.B.S, Urea, Na, K, and Cl
II. Nutrition Diagnosis
From the assessment I took, I was able to get the problem of the patient, its etiology and the
signs and symptoms. With BMI, I get to know whether the patient is SAM, MAM, normal, obese
or overweight.
III. Nutrition intervention
From knowing the patient problem, it is possible to identify the supplement basing on the health
status. For example a SAM patient is given RUTF on weekly basis which is equivalent to three
sachets per day for adults and one sachet per day for a child. For MAM patients they are given
FBF on monthly basis.
IV. Nutrition monitoring and evaluation
Once the patient has been given RUFT for SAM patient he/she is given a return date on weekly
basis for monitoring progress and a MAM patient he/she is provided with FBF and given a return
date on monthly basis.
3.2 MATERIALS USED DURING ATTACHMENT
I. MUACE tape
II. Weighing scale
III. Height board/length board
IV. BMI reference chart
3.3 SUPPLIMENTS
● RUTF
● FBF
● Fresubin
● Threptin diskettes
● Supportan
● Profile extra

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CHAPTER FOUR
4.0 AREAS COVERED
4.1 PEDIATRIC WARD
It is a medical ward for all children of ages between (0-16years). The ward cover various
medical conditions basing on their health status.
These conditions include pneumonia, meningitis, marasmus, kwashiorkor, Diabetes and other
malnutrition disease.
In this pediatric it is in divisions that is acute room, which is for the sick children for growth
monitoring, Acute two is for burns, marasmus & kwashiorkor children. Acute three is for
medical conditions such as malaria and other diseases, acute four is also for medical and acute
five is for children who have been discharged and have not cleared the hospital bill.
The role of nutritionists in this ward is to carry out nutrition assessment which is weight, height
or length and calculate the z-scores, carry out clinical observation and check on the biochemical
test from the assessment the nutritionist is able to get the nutritional diagnosis of a particular
patient, then able to give out nutrition intervention that is offering nutrition counselling, nutrition
education and to supplement the patient according to his/her status and offer return date to enable
in monitoring the patients’ progress
Case study
● Patient x
● Age 2years
● Dx severe malaria/anaemia
Clinical observation
● Pallar
● Febrile
Biochemical test
● h.b of 5.9 g/dl
Anthropometric measurements
● WT.8.84Kg
● HT. 78cm
● Z-scores – 1SD(mild)
NDX: inadequate intake due to lack of appetite as evidence by Z-scores of -1SD (mild)

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Nutrition intervention.
● Nutrition counselling on diet intake
● Encourage the mother to maintain hygiene
● Counsel the mother to adhere to TCA
● Monitor progress
4.2 MOTHER CHILD HEALTH (MCH)
It is an area in the hospital where both mothers and children attend for their clinic. It comprises
of different department.
4.2.1 Registry room
It a room in M.C.H where all mother register themselves, before attending the clinic, before
attending the clinic. They are provided with clinic book for further references.
4.2.2 Growth and monitoring room
It is a room whereby there is frequent check up of children’s weight; there is plotting of graphs to
show whether the child is gaining, loosing or static basing on weight measurements. Children at
the age of 6m0nths, 1yr, 11/2 2, 21/2, are given vitamin A, to prevent from opportunistic
infections. Also mothers who had delivered for the first 6wks are give vitamin A, counselling of
mothers on importance of exclusive breastfeeding.
4.2.3 Nutrition counselling room
In counselling room, I was able to assess the mothers and children who came to the room.
Supplements are given out basing on the nutrition diagnosis of the patient. Counselling and
education is offer basing on health status.
4.2.4 Immunization room
It is a room whereby children are offered vaccination basing on different ages get to know the
type of vaccination given out on the child’s health book.
The immunization given out include BCG vaccine which is given at birth, polio vaccines given
at birth or within the two weeks.
The vaccines given out as follows
● BCG at birth, for children below one year they are given (0.05mls) and children above
one year is (0.1mls)
● Polio vaccines; they are given out at birth or within the fist two weeks. The first dose at
six weeks, second dose at ten weeks and third dose at fourteen weeks.
● Diphtheria/pertussis/tetanus/hepatitis B/ Haemophiluz influenza type b; the first dose is
given at 6 weeks, second dose at ten weeks and third dose at 14 weeks.
● Rota virus vaccines; the first dose is given at 6 weeks and second dose at 10 weeks
● Pneumococcal vaccines; the first dose at 6 weeks, second dose at ten weeks and third
dose at fourteen weeks.
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 ● Measles rubella vaccines; they are given at 9 months for the first dose and 18 months for
the second dose
● Yellow fever vaccines; they are given at 9 months
4.3 SURGICAL WARD
This is the ward where by the patients with different conditions undergo theatre operations. In
this ward there is dressing of wounds at different critical and therefore patients admitted in this
ward require light diet to enable in healing process. The patients are not given the normal diet
since it may cause difficulty in the digestion systems and may lead to worsening of the healing
process of the wound.
Case study
● Patient y
● Age 78 years
● Dx Anaemia
Clinical observation
● Sunken eyes
● Pallar
● Wasted
Clinical observation
Hb. Of. 8.0g/dl
Anthropometric measurement
● MUAC – 15.8cm
NDX
Severely acute malnourished in severe Anaemia as related to in adequate dietary intake as
evidence by low appetite and MUAC of 15.8cm
Nutrition plan
● Give fresubin 2kcalX2/5
● Encourage iron rich foods
● To take high vitamin C diet
● Suppliment with Ranferon 10mls

4:4 FEMALE WARD

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It is a ward comprising all adult females whereby all diagnosis are admitted.The ward comprises
of six cubes one is for critically ill patients
The condition handled in this ward include Diabetes, anemia Hypertension and malnutrition
cases
In this ward I was able to carry out Nutrition assessment for the patients. I offer nutrition
management basing on there diagnosis and also give out nutrition counselling basing on their
health status.
I gave out supplementation to the patients basing in their nutrition, health. Examples of
supplements include RUTF in SAM patients, Fresubin, supportan energy drink. Threptin. I
document on the file after every counselling.
Case study
● Patient Z
● Age 40yrs
● DX pellagra in severe Anaemia
Clinical observation
● Flaky dermatitis in hands
● Pallar
● Wasted
Bio chemical assessment
● h.b 5.5 g/dh
Anthropometric measurements
● MUAC. 18.5cm (MAM)
N.DX
● MAM in pellagra as related to inadequate intake of Niacin rich food as evidence by flaky
dermatitis and MUAC of 18.5cm
Nutrition intervention
● Encourage the patient on iron rich foods
● Encourage on Niacin rich foods
● Counsel on intake of high protein and high vitamin C foods
● Do RUTF appetite
● Monitor progress

4.5 MALE WARD

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This is a ward for all adults male whereby all condition of illness are handled. The ward is
divided into six cubes; basing on different conditions admitted. Examples of conditions include
hypertension, diabetes, anaemia, malnutrition.
As a nutritionist I was able to work together with the staff especially during the ward duration to
enable me get to know the condition each patient is undergoing. I gave out nutrition supplement
basing on the patients nutrition health status. I.e. The supplement to in-patients include, threptin,
supportan, provide extra and fresubin
In general I was able to carry out any nutritional counselling to patients basing on their nutrition
health status. I then document on the patient file.
Case study
● Patient y
● Age 45yrs
● Dx DNA in I.S.S
Clinical observation
● Skin rashes
● No pallar
● Not wasted
Biochemical assessment
● h.b 12.5g/dl
N.Dx
● MAM in newly DNA in ISS due to inadequate dietary patterns as evidence by skin rashes
and MUAC of 17.5cm
Anthropometrics measurements
● MUAC-17.5cm (MAM)
Nutrition intervention
● Encourage on small frequent feeds
● Provide with enteral supportant energy
● Drink 200mls BDX5/7
● Monitor progress

4.6 TUBERCLOSIS WARD

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 This is an isolation ward for TB patients. I took in this anthropometric measurements in this
ward as a nutritionist, I was able to give out nutrition counselling basing on the patients health
status. I supplement some of them basing on their nutritional diagnosis then document on their
file and gave monitoring progress.
Case study
● Patient y
● Age 65yrs
● Dx TB
Clinical observation
● Wasted
● Sunken eyes
● Brittle hair
Biochemical assessment
● H.b 13.0 g/dl
Anthropometrics measurement
● Weight – 49.0 KG
● Height – 175 cm
● BMI – 16 kg/m2 (SAM)
NDx
● Acute malnourished as related to inadequate dietary intake as evidence by brittle hair and
BMI of 16
Nutrition intervention
● RUTF for appetite taste
● Encourage on high protein diet to build the tissues
● Carbohydrate should be high to provide with energy
● Counsel on hygiene
● Monitor progress

4.7 MATERNITY WARD

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This is a ward where by mothers who have delivered stay for monitoring before being
discharged. My role as a nutritionist in this ward is to give out Vitamin A to mothers, and access
those with oedema because intake of vitamin A to oedema patients causes toxicity. Again at
maternity ward I was able to give nutrition education on importance of exclusive breastfeeding
for the first six months, positioning of the baby, cleanliness and hygiene and on diet intake to the
mothers to enable the children get enough breastmilk.
4.8 OUTPATIENT DEPARTMENTS
4.8.1 Comprehensive care Centre (CCC)
It is an out-patient clinic. The clinic is in two divisions. It is the only for HIV positive patients.
The divisions comprises of Triad clinic and pediatric clinic.
Nutrition assessment is carried out, from identify the diagnosis, it is possible to get the
intervention of a patient basing on nutritional health status. I get to give nutritional counselling to
patients who were SAM, MAM and obese to accept their health status despite of being HAART
patients. The supplement given out at CCC to SAM patients are RUTF to treat under nutrition
and for MAM patients they are provided with FBF
Case study
● Patient z
● Age 28 yrs.
● Dx SAM
Clinical assessment
● Wasted
● Brittle hair
Anthropometrics measurement
● Weight 39.5 KGs
● Height – 156 cm
● BMI – 16.5 KG/m2 (SAM)
NDx
Severely acute malnourished as evidence by BMI of 16KG/m2
Nutrition intervention
● RUTF appetite taste
● Counsel on small but frequent intake of diet
● Observation of hygiene and sanitation
● Take frequent of clean safe water
● Follow up

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4.8.2 Chest clinic
It is an outpatient clinic for patients with tuberculosis. In this clinic anthropometrics
measurements are carried out that is weight, height and calculating BMI. Patients who are newly
diagnosed with TB are given vitamin A and also to severely malnourished patients.
Supplements offered in this clinic include RUTF and FBF. Nutrition counselling is carried out
that is educating the patients on good hygiene and sanitation, counsel to use a handkerchief while
coughing.
Case study
● Patient x
● Age 45 yrs.
● Dx TB
Clinical assessment
● Wasted
Anthropometrics measurements
● Weight – 33KGs
● Height – 140 cm
● BMI – 17KG/m2
N.DX
● Severely acute malnourished as evidence by BMI of 17KG/m2
Nutrition intervention
● Provide with fortified blended flour
● Counsel on hygiene and sanitation
● Encourage on high protein diet
● To take frequent of fluids
● Give dare of return for follow up.

4.8.3 MOTHER CHILD HEALTH

It is a clinic unit for both mother and children. Regular weighing is carried out in this clinic.
There is nutrition counselling room in this department where by a case of severely malnourished

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mothers and children without complication are given RUTF to treat under nutrition on weekly
basis, and for moderately acute malnourished patients are given FBF and on monthly basis.
For pregnant mothers, I was able to take their MUAC and counsel Nutrionally. At PMTCT
whereby HIV positive mothers attend for medication. In PMTCT I counsel mothers on exclusive
breastfeeding so long as the mother is on ARVS and the child on septrin drugs to prevent the
transmission of the virus to their children. For mothers who HB level were low, I counsel on iron
rich food, high vitamin C diet and to take high protein diet.
Case study
● Patient y
● Age 30 yrs
● Dx MAM in severe anemia
Clinical assessment
● Pallar
Biochemical assessment
● H.b 6.5g/dl
Anthropometrics measurement
● MUAC – 21.5 cm
N.Dx
Moderately acute malnourished related to inadequate intake as evidence by BMI of 21.5cm
Nutrition intervention
● Encourage on iron rich food & high vitamin C diet
● To attend ANC frequently
● Provide with advantage flour.

5.0 RESULTS /FINDINGS

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On my attachment I was able to go through experiences. Kericho County Referral hospital was a
friendly environment where by the staff members were willing to give direction, corrections and
consult whenever challenges arose.
I was able to learn how to carry out nutrition assessment, give out interventions for different
conditions of the patients. I was able to learn at what stage I should give out F75 and F100 in
pediatric wards.
I got to know supplementation given to HAART patients under different conditions like
vomiting and diarrhea; examples of those supplements include fresubin, supportant energy drink
threptin and profile extra.
During my attachment period I was able to learn medical terms.
5.1 CHALLENGES ENCOUNTERED
Was not able to access all the places in the institution, like theatre, renal unit and thus hinders the
accessibility of information carried out in those areas.
Since the doctors were on trike at the beginning of my attachment I was not able to access the in-
patient department for a short duration of time due to that there was less work done in the in-
patient compared to out-patient department.
5.2 ACTIVITIES AND EXPERIENCES
During my practicum session which lasted for three months, it gave me a chance to explore all
theories I had learnt in school and how to put in practice. I learn the role of food in nutritional
management of various diseases. The activities include nutrition counseling. Working with
medical staff enabled me offer nutrition care to the patients, it was fantastic in a way that I got to
learn of different medical conditions during the withdrawn and the management of those
medically and nutritionally.
My experience is that I was able to interact with different staff in the hospital and get to learn
from different departments, concerning the conditions they handle from patients and how they
manage basing on medication and nutrition.

5.3 SPECIFIC ACTIVITITIES RELATED TO NUTRITION COURSE

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Nutrition assessment of the patient
All the patients admitted in the hospital need to be assessed. That is taking their weight, height,
calculating BMI and Z-scores for children. Identifying their diagnosis in order to get to know the
supplementation to be given. Assessment helps to identify the nutritional status of the patients
and the nutritional plan.
Nutrition counselling
It is a way of giving nutrition skills and knowledge to the patient with different conditions and
diet management.
Writing of the nutrition notes
After every counselling section it is important as a nutritionist to document on the patients file.
In that information it will ensure any medical staff to access the status of the patient and get to
know the proper medication to be offered.
Meal supervision
As a nutritionist it as good to plan a diet for patients basing on their different medical condition.
This was done in the hospital by use of the diet sheet. The importance of meal supervision
ensures that patients with different conditions get right food as per their status
Supplements
After nutrition assessment of all the patients, one is able to get the diagnosis thus enabling giving
out supplement basing on their nutrition health status that will help boost on their immunity and
provide nutrition ingredients to the body at whole. For every patients who was given supplement.
It was a rule to indicate on the register book the details of patients and the type of supplements
given.

6.0 DISCUSSIONS

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During my attachment at Kericho County Referral Hospital. I was able to know the calculation
of f-75 and F-100 at pediatric ward. On daily basis on place of work I usually collect the diet
sheet of all the patients admitted in various wards, indicating the condition of diabetes patients,
burns and hypertension to ensure that the patient get prescribed diet.
In the wards I attended the ward drawn where by I learnt to get to know the cause of the
conditions they were undergoing.
I learnt on how to prepare the resimols and its importance on the patient
I learnt that Pre-Nan are specific formula for feeding of preterm and low birth babies or infants,
since it has adequate protein and calories and are easily digested.

7.0 CONCLUSIONS

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Being in Kericho County Referral Hospital I was able to get the right practical skills that I had
learn theoretically in class. I was able to interact with the environment and the set up of the
institution and I got to learn on management of various medical conditions related to nutrition.
Examples of the conditions include diabetes, anaemia, and hypertension. In conclusion I would
like to appreciate Kericho County Referral hospital for the opportunity they offered me to me in
their institution and thus they enable me to explore all the skills and knowledge based on
conditions handle in various wards.
I also thank Kenyatta University and the department of food nutrition and dietetics for the skills
and knowledge learnt in class in that they were able to give me a chance for practicum session to
enable me put it in practical

8.0 RECOMMENDATIONS

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8.1 To the attachment institution
I would like to request the Kericho County Referral Hospital department of nutrition if possible
to put on their schedule time to allow the attachee exposed on the community work
I would like to request the department to increase the number of nutritionists so that in every
station they have at least one nutritionist.
8.2 To the department on training
I would like to request my college department of food nutrition and dietetics to offer students
more of the practical so as to allow to us to familiarize on practical skills and knowledge. I
would like to request the department to increase on the tools that would enable us familiarize
before starting on our practicum session.

9.0 REFERENCES

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 ● Training policy
● Kericho County Referral Hospital terms and conditions of services
● kerichodistricthospital@yahoo.com

10.0 APPENDICES

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KERICHO COUNTY REFERRAL HOSPITAL ORGANIZATION
MEDICAL SUPERITENDANT

DEPUTY MEDICAL SUPERITENDANT

HODs

HAD Nursing Department C.C.C

Pharmacy Department M.C.H
Clinical Officers Out patient Department Wards
Clinical Department Store
Support staff Bio – medical Department Kitchen
Public Health Department Mortuary
Nutrition Department
Laboratory
Emergency Care Department

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