Health/Technology: Kwashiorkor: dangerous but curable

Kwashiorkor is a physical health condition resulting from inadequate protein intake. It mostly occurs in areas hit by famine, limited food supply, and low levels of education leading to inadequate knowledge of diet and feeding techniques. Early symptoms of any type of malnutrition are very general and include fatigue, irritability, and lethargy. As protein deprivation continues, there is growth failure, loss of muscle mass, generalized swelling of body parts and decreased immunity. Severe kwashiorkor leaves a child with permanent mental and physical disabilities. There is statistical evidence that early malnutrition permanently decreases the intelligence quotient of the child. Anna Kayitesi, a nutritionist expert at Nutrition Aid for Rwanda (NUTRAID), an Italian NGO feeding centre in Butare, says that children with kwashiorkor are likely to have skin conditions such as dermatitis and changes in pigmentation, thin hair and vitiligo. Kayitesi adds that kwashiorkor was on the rise in Rwanda immediately after the 1994 mayhem, but it has since drastically decreased due efforts by the government to create awareness among its citizens through encouraging them to work. Improving calories and protein intake will correct kwashiorkor provided that treatment is not too late. However, full height and growth potential will never be achieved for such children. Malnourished children come with other ailments as well because they are more vulnerable to bronchial chest infections, diarrhoea and skin infections. Jean-Claude Gakwaya, a child who once suffered from kwashiorkor and was rescued by the nutrition centre, admits that kwashiorkor cases have reduced in the country because all types of foodstuffs necessary for growth are available. “When there is peace you can not see a malnourished child because all types of food are in the household,” says Gakwaya. Treatment of kwashiorkor varies depending on the severity of the condition. Shock caused by the disease requires immediate treatment with restoration of blood volume and maintenance of blood pressure. Calories can be applied early in form of carbohydrates, simple sugars, and fats. Proteins are given after other caloric sources have already provided increased energy. Vitamin and mineral supplements are essential. However, starting oral feedings, especially if the child’s caloric density is too high at first can present problems. Food must be re-introduced slowly with carbohydrates at the initial stage to supply energy followed by protein foods. Although significant clinical differences between kwashiorkor and marasmus exist, studies suggest that marasmus represents an adaptation to starvation whereas kwashiorkor represents lack of adaptation to starvation. In addition to Protein-energy malnutrition, children may be affected by micro-nutrient deficiencies, which also have a detrimental effect on growth and development. The most common and clinically significant micronutrient deficiencies in children and childbearing women throughout the world include lack of iron, iodine, zinc and vitamin A. Nutritional surveys in several African regions like in Ethiopia are already showing increased cases of malnutrition such as marasmus and kwashiorkor among children and the elderly. A balanced diet for expectant mothers is required to avoid such deficiencies that may also cause kwashiorkor among children. The writer is a general medical practitioner. Contact: josephmunich06@yahoo.co.uk