ABC of nutrition. Malnutrition in the Third World--II.

Abstract

The diagnosis and management of malnutrition in 3rd world countries have to be primarily a public health operation. Many of the malnourished live in shanty towns or remote rural areas. They have no access to a central teaching hospital. Health manpower is inadequate. When there is not enough food for an entire community stop growing and children and adults lose weight. Symptoms include thirst craving for food weakness feeling cold nocturia amenorrhea and impotence. The extremities are cold and cyanosed. Odema may be present. Temperature is subnormal. Subcutaneous fat disappears skin turgor is lost and muscles waste. Psychologically starving people lose initiative; they are apathetic depressed and introverted. In advanced malnutrition patients become completely inactive and may assume a flexed fetal position. Infections are to be expected especially gastrointestinal infections pneumonia typhus and tuberculosis. In the body plasma free fatty acids are increased. Mild starvation occurs when ones weight for height is 90-80% of the standard; moderate starvation occurs when weight for height is 80-71% of the standard; severe starvation occurs when weight for height is 70% or less of the standard. In 3rd world countries about 2% of young children show severe protein-energy malnutrition (PEM) Nutritional marasmus is the commonest severe form of PEM the childhood version of starvation. Kwashiorkor is less common than marasmus. It is most common in poor rural children. Treatment of severe protein-energy malnutrition is in 3 phases: resuscitation; start of cure; and nutritional rehabilitation. 5 measures to prevent PEM adopted worldwide are: growth monitoring; oral rehydration; breastfeeding; immunization and family planning.