Malawian Dietitian Breaks New Ground in Hospital Nutrition

Jonathan Misolo, RD

Hospitals in Malawi did not have registered dietitians to identify and treat disease-related malnutrition until 2017. The Government of Malawi responded to this urgent need to train and license nutrition experts in its 2010 national nutrition strategy. It teamed up with the United States Agency for International Development, in collaboration with Tufts University’s Feed the Future Innovation Lab for Nutrition, Lilongwe University of Agriculture and Natural Resources, and the College of Medicine, University of Malawi to create the country’s first postgraduate dietetics degree program.

Jonathan Misolo, RD (pictured left) was one of four students admitted to the inaugural program in 2016. His early exposure to medicine sparked his interest in nutrition work. “I have a medical professional background. Little did I know that food is medicine,” he explains.

In 2017, Jonathan joined his classmates in the first dietetics department at Kamuzu Central Hospital, an 800-bed tertiary hospital in the capital city of Lilongwe.

Since then, Jonathan has been promoted to head dietitian of the hospital. He says, “I have to balance a patient’s energy requirements against what he or she is getting from the hospital meals. At the same time, the hospital expects improved nutritional status of patients while in the ward as well as during discharge. They do not expect recurrent re-admissions of conditions managed by [a] dietitian. They also expect better food service management.”

Both malnutrition-related health conditions as well as chronic non-communicable diseases (NCD) like diabetes and hypertension are significant public health issues in Malawi. Jonathan’s area of interest is the nutritional management of type 2 diabetes mellitus. He cautions, “All non-communicable diseases have a dietary component as far as prevention and management are concerned.” Using his skills and training in nutritional education, counseling, and diet monitoring, he teaches NCD patients how to modify their diets, recommends ways to change their eating behaviors, and monitors the nutritional intake of seriously ill patients.

The global COVID-19 pandemic upended the country and severely impacted Kamuzu hospital. Shortages in nutritional supplies required Jonathan to modify patients’ diets using food available at the kitchen stores. The hospital also had to suspend its out-patient diabetic and hypertension clinics, but both have since reopened. He and his team of frontline health workers still attended to patients, using protection and sanitary measures. “The patient-dietitian ratio is still great, and we are able to review all patients in critical care wards on a daily basis and follow up with them.”

Jonathan is confident that a registered dietitian’s career path is wide open for advancement and growth. He believes, “There is [an] untapped market for dietetics in Malawi. The general population is now becoming cautious with their dietary intake. There are non-communicable diseases which necessitate [a] dietitian’s management.” 

Jonathan and his cohort of new dietitians now have the potential to shape the direction of patient care in dietetics and are continuing to work towards advancing nutrition in Malawi. As he says, “Supporting the health and nutrition of critically ill patients requires extensive reading as medicine is dynamic. We are at the forefront of making a real difference in providing clinical nutrition services in Malawi.”

Support for the work in Malawi was provided by the Feed the Future Innovation Lab for Nutrition which is funded by the United States Agency for International Development (USAID).