Assessing Severe Malnutrition in Bolivian Children. Kwashiorkor in Latin America?

Abstract

Introduction. Malnutrition (MN) has decreased globally, but there are areas in Latin America where it continues being a significant health problem. In Bolivia MN is prevalent and there is no information about Kwashiorkor (Kw), a clinical presentation with high mortality rate. Objective: To characterize MN among children admitted to Centro de Pediatria “Albina R. de Patino” (Cochabamba, Bolivia) for severe MN. Methods: longitudinal, descriptive assessment of relevant clinical data from all children admitted for severe MN during 2000–2001. Data were obtained from clinical records. Results. Of 2493 admissions in 2000/2001, 120 were severely malnourished children; two cases were excluded because their MN was secondary to other conditions. Therefore, 118 cases were analyzed (F/M: 56/62). Edematous forms of MN and Kw were more frequent (90% of cases) and occurred at older ages (median 15.2 in Kw vs 9.7 months in marasmus; p <0.01, KWallis). On admission, 40% of children with Kw were above -2 SD for W/A. 61 patients were dehydrated; in 26% of them dehydration was severe (≥10%) and 7% were in shock (total= 20 cases). Total hospital mortality rate for the analyzed period was 5.2%. 24 of the 118 children admitted for severe MN died (20.3%); of those admitted with severe dehydration (n= 20), 45% died (n= 9). The most frequent causes of death were sepsis (n=14) and respiratory infections (n=7). More than 50% of deaths occurred within 48 hours of admission. The main risk factors for death were low albumin (<2 g/dL), pneumonia on admission, sepsis, severe dehydration and W/L < -2SD. Risk of death among patients admitted for severe MN was four times greater than in the rest of children admitted in the period (OR= 4.8, CI 2.87 – 7.98, p <0.001). Conclusions. Edematous forms of MN were prevalent among children admitted for severe primary MN and they weighed considerably on mortality. For successful nutritional interventions it is crucial to incorporate to the analysis children with severe MN plus edema, which are missed by anthropometric standards. We propose to incorporate in hospital and primary health care statistics the presence/absence of edema as criterion to define and register the condition.