Introduction
Kwashiorkor is a form of severe protein energy malnutrition characterized by oedema, irritability, anorexia, ulcerating derma, irritability and enraged liver with fatty infuriates (Kerbs & Hambridge, 2011). Sufficient calorie intake, but with insufficient protein consumption distinguishes it from marasmus. Kwashiorkor cases occur in areas of famine or poor food supply; however, cases of kwashiorkor in developed world are rare (Howard, 2011).
The name kwashiorkor which was derived from the Ga Language” of Coastal Ghana, translates it as a sickness which a baby gets when the new baby comes and also reflects in older child which has been weaned from breast milk. Kwashiorkor may develop after a mother weans her child from breast milk, replacing it with a diet high in carbohydrates, especially starch, but deficient in protein. Jamaican paediatric Cicely Klielians introduced the name into medical community in 1935 in Lancet article.
Conceptual framework
Kwashiorkor is a nutritional deficiency disease of infant and children due to low quantity and quality protein but adequate calories in the diet (Betty, 1999). It can be seen vividly that kwashiorkor occurs from inadequate intake of protein into the body for growth and development, as well as repair of the tissue of the body tissues. And this results in stunted growth and possible infections.
Lantham (1984) states that kwashiorkor can be proven by children whose mothers died during delivery. And also, ignorance on the part of the parents concerning the child’s need for protein food can result to kwashiorkor. Another is children brought up in an unhealthy and unhygienic environment do have frequent diarrhoea which lead to kwashiorkor. He also stated that children whose mothers became pregnant and were suddenly weaned carbohydrates are of high risk of the disease.
Conversely, the disease can be treated by adding food rich in energy and protein to the diet. However, it can have a long-term impact on the child’s physical and mental development and in severe cases may lead to death.
Causes of kwashiorkor
According to Stephen (1994) the causes of kwashiorkor are outlined as follows;
- Ignorance about adequate diet.
- Infection such as diarrhoea, measles and pneumonia.
- Cultural belief and food taboos.
- Failure to introduce weaning diet on time.
- Occupation of the mother which prevent her from staying at home enough to take care of the children’s diet.
- Family sizes, such as families find it difficult to provide nutritional need of the children thereby exposing them to the danger of kwashiorkor.
Clinical manifestation (signs and symptoms)
According to Saunders (2011) the clinical manifestation of kwashiorkor are as follows;
- Changes in skin pigment. The skin of the child will be dry.
- Decreased muscles mass
- Diarrhoea
- Failure to gain weight and grow: the child will not grow very well and will be losing weight at all time.
- Fatigue
- Hair changes (change in colour or texture).
- Increased and more severe infections due to damaged immune system.
- Irritability
- Large belly that sticks out (protrudes)
- Lethargy or apathy
- Loss of muscle mass
- Rash (dermatitis)
- Swelling (oedema)
Complications of kwashiorkor
According to Wardlaw (2003), the following are complications of kwashiorkor;
- Anaemia
- Stunted or retarded
- Shock
- Low intelligence quotient (IQ)
- Susceptibility to infection
- Heart failure/coma
- Death
Treatment of kwashiorkor
The treatment is to improve the diet by the addition of good quantity and quality protein. For children that are still breastfeeding, the mother is advised to prolong the breastfeeding period until the condition is stabilised. Those that have stopped breastfeeding adequate quality of protein diet is given such as eggs, crayfish, beans, snail, fish and meat etc. for children taking pap, soya beans can also be added to the pap. The suya beans are also used to mix any food that the child will depend on the treatment given immediately.
According to Saunder (2011), the treatment are as follows;
- Getting more calories and protein will correct kwashiorkor, if treatment is started early enough. However, children who have this condition will never reach full potential for height and growth. Treatment depends on the severity of the condition. People who are in shock need immediate treatment of blood pressure.
- Calories are given fresh in the form of carbohydrates, simple sugars and sources of calories have already provided energy. Vitamin and mineral supplements are essential.
- Since the person will have been without much food for a long period of time, eating can cause problems, especially if the calories are too high at first food must be reintroduced slowly.
- Carbohydrates are given first to supply energy, followed by protein foods. Many malnourished children will develop intolerance to milk sugar (lactose intolerance). They will need to be given supplements with the enzymes lactose so that they can tolerate milk products.
Prevention of kwashiorkor
According to Krawinkel (2003), prevention of kwashiorkor are as follows;
- Health education: The health education should start from the antenatal clinic where mothers are advised to take more protein less carbohydrates and small fat in order to produce a strong and small fat in order to produce a strong healthy and vigorous infants
- The importance of family planning will help space childbirth and provision of family planning services.
- Food demonstration: Teach mothers on adequate diet during welfare clinic and also weaning diet.
- Advice mothers on exclusive breastfeeding.
- Mothers should be advice to get protein from locally available foods in the community.
- The child should be de-wormed periodically
- Immunization of the child to protect him/her against the deadly disease so that the child can grow well.
According to Ivan (2010) stated that kwashiorkor can only be assured through a change in the living conditions of the child and the community. This must include the education of mothers and their caregivers provisions of balanced diet, improved hygiene, clean water, as well as prevention and treatment of repeated infections such as gastro-intestinal infections, measles, HIV and TB. Alternative names, protein energy malnutrition, protein-calorie malnutrition and protein malnutrition.
Kwashiorkor is preventable by the provision of a balanced diet, adequate housing, accessible clean, safe water and proper sanitation together with economic upliftment and prevention of infection. Public education to teach mothers on how to improve their children’s diets, apply basic hygiene and utilised monitoring and preventive programme made available by the department of health, is important to ensure that children do not develop kwashiorkor and subsequent stunting. In order to grow normally and to remain healthy, a child will need 330-500 kj/kg per day for the first few years of life. This is divided so that 9-15% of the daily energy requirement is protein, 45-55% is carbohydrate and 35-45% is fat. Generally, the lower the fat intake, the better. Vitamins and mineral supplement are also helpful.
References
Betty, T.E. (1999). Kwashiorkor from a severe dietary restriction in an 8-month infant in suburban Detroit, Michigan: case report and review of the literature”. International Journal of Dermatology 49 (5): 500–506.
Howard, R.N. (2011). “Kwashiorkor in the United States: Fad Diets, Perceived and True Milk Allergy, and Nutritional Ignorance”. Archives of Dermatology 137 (5): 630–6.
Ivan, J. L. (2010). The quality of the diet in Malawian children with kwashiorkor and marasmus. Matern Child Nutr. 2:114-122.
Kerbs, N. F. & Hambridge, K.M. (2011). Normal childhood nutrition & its disorders. In: Current Pediatric Diagnosis & Treatment. New York; McGraw-Hill.
Krawinkel, C. H.(2003). Antioxidant supplementation for the prevention of kwashiorkor in Malawian children: randomised, double blind, placebo controlled trial. BMJ. 330:1109.
Latham, M.C. (1984). Protein-energy malnutrition – its epidemiology and control. J Environ Pathol Toxicol Oncol. 10:168-180
Saunders E. (2011). Epidemiology and prevention of severe malnutrition (kwashiorkor) in Central America. Am J Public Health. 47:53-62.
Stephen, L.E. (1994). Epidemiology of famine in the Nigerian crisis: rapid evaluation of malnutrition by height and arm circumference in large populations. Am J Clin Nutr. 24:358-364.
Wardlaw, G. M. (2003): Contemporary Nutrition: Issues and Insight. 5th edition. New York: McGraw Hill.
Williams, C. (1935). “Kwashiorkor”. The Lancet 226 (5855): 1151.
