Malnutrition

What is Kwashiorkor?

Protein-calorie malnutrition is called KWASHIORKOR. It is most common among children living in deprived circumstances. Treatment takes the form of gradually improving and balancing the diet. With early treatment the prognosis is good, but stunted growth is common. Prevention of kwashiorkor can only be assured through a change in the living conditions of the child and the community. Alternative names protein energy malnutrition, kwashiorkor, protein malnutrition. The name “kwashiorkor” is said to come from West Africa and means “deposed child”. Kwashiorkor is a nutritional disorder of children that occurs after a baby is weaned from the breast. If treated promptly, the prognosis is good, but many patients have stunted physical development. Very underweight children with kwashiorkor are known as marasmic-kwashiorkor.

What causes kwashiorkor?

Kwashiorkor is essentially a disease of poor socio-economic conditions. The most commonly accepted cause of kwashiorkor is a low-protein and inadequate energy (calorie) diet, together with a lack of other nutrients. Breastfed babies, even those living in impoverished communities, usually receive sufficient amounts of protein, carbohydrate, fat and other nutrients such as vitamins in the breast milk. When the child is weaned to an inadequate diet, kwashiorkor may develop. The situation is exacerbated where disease is rife and sanitation is poor.

Who gets Kwashiorkor and who is at risk?

Children living in overcrowded, poverty-stricken conditions are most at risk of developing kwashiorkor, especially if: They have recently stopped breastfeeding, and their diet consists largely of carbohydrates. Living conditions are unhygienic. Conditions in which food is stored or prepared are unhygienic, allowing it to become contaminated with fungi. Conditions encourage the growth and spread of moulds or fungi. There are frequent outbreaks of disease in the community. The child’s immune system is low due to starvation or disease. Diarrhea and dehydration are present.

Symptoms and signs of kwashiorkor

Symptoms

• Failure to gain weight and failure of linear growth
• Irritability
• Lethargy or apathy
• Decreased muscle mass
• Swelling (edema)
• Large belly that stick out (protrudes)
• Diarrhea
• Dermatitis
• Changes in skin pigment; may lose pigment where the skin has peeled away (desquamated) and the skin may darken where it has been irritated or traumatized
• Hair changes — hair color may change, often lightening or becoming reddish, thin, or brittle
• increased and more severe infections due to damaged immune system
• Shock (late stage)
• Coma (late stage)

Early symptoms of kwashiorkor are fairly non-specific. They are underweight for age. An affected child may at first appear tired, irritable and disinterested in play. The child fails to grow and loses muscle mass. As deprivation continues, the child’s legs and body swell up due to the accumulation of fluid (edema) in the tissues. A “pot-belly” develops because of lax abdominal muscles and, in some cases, an enlarged liver. The hair becomes sparse, brittle and develops a reddish hue. In severe cases patches of the skin will slough off leaving oozing sores rather like a burn wound. They are often anemic and have heavy worm infestations. Diarrhoeal disease is a frequent presentation. Because of impaired immunity these children are also prone to infections such as tuberculosis and septicaemia. Final symptoms may include coma or shock. If untreated the child will die.

http://www.dhyansanjivani.org/diseases/Protein_malnutrition.asp

EXAMPLES OF KWASHIORKOR

Soufrilia the day she was admitted

After a few weeks—the swelling “water weight” has gone down

This is her going home