Malnutrition among children in the tropics: A clinical study of 350 cases

Abstract

1. 1) A study of 350 undernourished and malnourished children admitted to the hospital during 1957–1960 is reported. They comprised (i) kwashiorkor (oedematous and fatty type) with or without dermatosis—123 cases. (ii) Marasmus (wasted type) with or without oedema—163 cases; 64 children with tuberculosis were excluded from the series. 2. 2) The syndrome was most frequently seen in children between the ages of 6 months and 3 years. 3. 3) The condition was associated with weaning or inadequate breast milk, inadequately supplemented with starchy foods (sago, barley, sugar). The diet was grossly deficient in proteins and had also insufficient calories in many cases. Respiratory and alimentary infections contributed to the pathogenesis. 4. 4) The clinical and biochemical features are briefly mentioned. In marasmus the onset was insidious, the wasting was often extreme and the liver was not fatty. In kwashiorkor the onset was somewhat acute; there was little or no wasting and the liver moderately enlarged with fatty changes in the parenchyma. In both the serum proteins and albumin were lowered, especially in kwashiorkor. 5. 5) The mortality was high being 67 (23 per cent.) including 40 (14 per cent.) who died within 48 hours of admission and 14 (5 per cent.) who died suddenly in hospital. The immediate causes of death were diarrhoea, dehydration and respiratory infection. 6. 6) Autopsy in 29 cases revealed pathological changes in the liver, pancreas, intestines, heart, etc., with evidence of infection in the lungs. 7. 7) Treatment was initiated with skimmed milk which was gradually replaced by whole milk with the addition of other foods. Vegetable protein food prepared from Bengal gram ( Cicer arietinum) was also effective. Treatment of associated infection was almost as important as good diet. 8. 8) Eighty-four cases could be followed up. There were five deaths, 12 relapses and 24 children with chronic ill health mostly due to digestive or respiratory infections. The rest had fairly good health. On the whole, growth failure and ill health were more prominent in marasmus cases.