Wednesday, 11 June 2014 13:51

Malnutrition haunts sub-Saharan Africa through infant mortality

Written by ROBERT NYAGAH

The need to feed babies properly cannot be over emphasized when looked against a background where the World Health Organisation (WHO) indicates that malnutrition contributes to about 60 per cent of the 11 million deaths that occur each year among children less than four years old.

 

Closer home a research done in Kilifi County health facilities has confirmed that proper nutrition for babies at early stages plays a major role in ensuring better immunity from childhood ailments.

The study, which was carried out to determine infections associated with severe malnutrition among children admitted at Kilifi District Hospital showed that undernourishment predisposes affected children to various infections.

The study noted that undernourishment either worsens the children’s nutritional status or causes malnutrition, hence complicating management ailments attacking them.

According to Dr Bruno Sunguya, a specialist on nutrition related ailments at paediatric level: “Severe protein-energy malnutrition predisposed affected children to various infections, which either worsens their nutritional status or causes malnutrition, hence complicating their management and outcome.”

Leading the study in Kilifi, Sunguya notes that the proportion of male children with malnutrition was higher than that of female children. The study looked at 1,121 children found to be suffering from severe malnutrition who had been admitted to various health institutions among them Kilifi District Hospital.

According to Sunguya, more than 75 per cent of all patients with severe protein-energy malnutrition were children below two years.

“Thirty-six per cent of all severe protein-energy malnutrition cases had malaria while 45 per cent of all admitted patients had diarrhoea,” says Sunguya.

The study revealed that 64 or 19 per cent of the children with severe malnutrition died at Kilifi District Hospital. Septicaemia was also found to the leading cause of death at the hospital which affected 55 per cent among severely malnourished patients. Septicaemia is caused when certain bacteria get into the bloodstream. Without prompt medical treatment, it can be fatal.

The expert found septicaemia to be the most common cause of death followed by tuberculosis as well as HIV and AIDS.

“Most deaths at the hospital were noted among patients with septicaemia. Deaths among patients with severe malnutrition were mainly attributed to bacteraemia,” says the doctor.

He concludes that co-infections complicate the management of severe malnutrition and are associated with higher death rate.

Therefore, he notes, management of such infections are of paramount importance to reduce fatality rates.

The studies were done against a background where globally, malnutrition contributes to about 60 per cent of the 11 million deaths that occur each year among children less than four years old.

Protein-energy malnutrition was found to be more common in developing countries among children less than five years old, the severe form being between one to ten per cent and underweight between 20-40 per cent.

Malnutrition has been associated with over half of all child deaths in developing countries and presents mainly through kwashiorkor.

Kwashiorkor occurs in infancy but maximally in the second year following abrupt weaning while Marasmus involves inadequate intake of protein and calories, representing the end result of starvation.

Noting that marasmus occurred in the first year of life due to lack of breast-feeding and use of dilute animal milk, Sunguya explains that poverty, famine, ignorance and poor maternal nutrition were among the major contributing factors.

“Pre-school children in developing countries are often at risk of malnutrition because of their dependency on others for food,” explains Sunguya.

He adds: “Increased protein and energy requirements as well as immature immune system are to be blame for greater susceptibility to infections.”

According to past findings, severe malnutrition affects one to two per cent of pre-school children mainly in the developing countries.

Sunguya indicated that in East Africa, malnutrition was increasing in prevalence and remained a serious public health problem yet the ability of malnourished child to handle infections is lower.

At the Kilifi District Hospital where much of the data was collected, Sunguya found out that the institution serves a population of over 230,000 with the paediatric unit admitting more than 5,000 children per year.  

Mortality rates at Hospital increased with age, with the highest rate of 42 per cent and then decreased after the second year of life. The situation was worsened by the fact many foods fed on babies once they started feeding lacked required nutrients supply especially protein and calories.

According to Sunguya: “Diarrhoea, which has been the leading co-morbidity at Kilifi District Hospital, causes malnutrition due to inadequate absorption and loss of nutrients and water.”

However, Sunguya has a positive note for Kilifi District Hospital having been observed to strictly follow WHO guide on management of severe malnutrition, with proper case management.

That was a positive for the health facility because experts have found out that proper case management does reduce mortality to less than five percent.

“The most common complications, which kill patients with severe malnutrition, include hypoglycaemia, hypothermia, infections, dehydration and electrolyte imbalance,” says Sunguya.

He notes that co-infections were associated with majority of deaths among the malnourished children.


 

This article was originally published in the Reject 

 

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