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Case management of kwashiorkor: an intervention project at seven nutrition rehabilitation centres in Malawi

Source: www.hawaii.edu
Topic: Kwashiorkor
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Sort Desciption: Kwashiorkor is a form of severe protein-energy malnutrition in children characterized by oedema, irritability, anorexia, fatty infiltration of the liver, skin dyspigmentation, hair changes and reduced hepatic export proteins. ...

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Kwashiorkor is a form of severe protein-energy malnutrition in children characterized by oedema, irritability, anorexia, fatty infiltration of the liver, skin dyspigmentation, hair changes and reduced hepatic export proteins. The precise aetiology is still unclear, although many hypotheses have been advanced, such as protein deficiency, (Williams, 1935) methionine deficiency, (Roediger, 1995) pellagra, (Gillman and Gillman, 1951) dietary dysadaptation, (Gopalan, 1968) cyanogenic glucoside toxicity, for example, linamarin, in cassava, (Kamalu, 1993) a¯atoxin poisoning, (Hendrickse, 1983) ADH-like effect of free ferritin, (Srikantia, 1958) inappropriate endocrine responses, (Rao, 1974; Whitehead, 1981) and free radical damage (Golden, 1988). There are enormous regional disparities in the prevalence of kwashiorkor, and in regions where it is the predominant form of childhood malnutrition, it tends to be the final common pathway for nutritional insults such as food insecurity, a monotonous staple diet, chronic infections (TB or HIV), persistent diarrhoea and even cerebral palsy. As the most common form of severe malnutrition in Malawi, kwashiorkor (including marasmic-kwashiorkor) accounts for 75% of all admissions to Nutrition Rehabilitation Centres (NRCs) in the southern region. It has a high case-fatality rate at large hospital-based NRCs, which has changed little over recent decades despite an overall fall in under-five childhood mortality (Anonymous, 1995; Anonymous, 1994). ...

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