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. 1996;74(2):223–229.

Why have mortality rates for severe malnutrition remained so high?

C Schofield 1, A Ashworth 1
PMCID: PMC2486901  PMID: 8706239

Abstract

A review of the literature that has appeared over the past five decades indicates that the median case fatality from severe malnutrition has remained unchanged over this period and is typically 20-30%, with the highest levels (50-60%) being among those with oedematous malnutrition. A likely cause of this continuing high mortality is faulty case-management. A survey of treatment centres worldwide (n = 79) showed that for acutely ill children, inappropriate diets that are high in protein, energy and sodium and low in micronutrients are commonplace. Practices that could have fatal consequences, such as prescribing diuretics for oedema, were found to be widespread. Evidence of outmoded and conflicting teaching manuals also emerged. Since low mortality levels from malnutrition can be achieved using appropriate treatment regimens, updated treatment guidelines, which are practical and prescriptive rather than descriptive, need to be implemented as part of a comprehensive training programme.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Achar S. T. Nutritional Dystrophy Among Children in Madras. Br Med J. 1950 Mar 25;1(4655):701–703. doi: 10.1136/bmj.1.4655.701. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Brewster D., Manary M. Treatment of severe malnutrition. Lancet. 1995 Feb 18;345(8947):453–453. doi: 10.1016/s0140-6736(95)90435-2. [DOI] [PubMed] [Google Scholar]
  3. Briend A., Golden M. H. Treatment of severe child malnutrition in refugee camps. Eur J Clin Nutr. 1993 Oct;47(10):750–754. [PubMed] [Google Scholar]
  4. CARR W. R., GELFAND M. The results of treatment of kwashiorkor in Salisbury with high protein diets. Cent Afr J Med. 1956 Dec;2(12):425–429. [PubMed] [Google Scholar]
  5. CHAUDHURI R. N., BHATTACHARYYA A. K., BASU A. K. Kwashiorkor and marasmus in Calcutta. J Indian Med Assoc. 1961 Jun 16;36:557–565. [PubMed] [Google Scholar]
  6. Christie C. D., Heikens G. T., Golden M. H. Coagulase-negative staphylococcal bacteremia in severely malnourished Jamaican children. Pediatr Infect Dis J. 1992 Dec;11(12):1030–1036. doi: 10.1097/00006454-199211120-00008. [DOI] [PubMed] [Google Scholar]
  7. Coulter J. B., Suliman G. I., Omer M. I., Macfarlane S. B., Moody J. B., Hendrickse R. G. Protein-energy malnutrition in northern Sudan: clinical studies. Eur J Clin Nutr. 1988 Sep;42(9):787–796. [PubMed] [Google Scholar]
  8. Cousens S., Nacro B., Curtis V., Kanki B., Tall F., Traore E., Diallo I., Mertens T. Prolonged breast-feeding: no association with increased risk of clinical malnutrition in young children in Burkina Faso. Bull World Health Organ. 1993;71(6):713–722. [PMC free article] [PubMed] [Google Scholar]
  9. Erinoso H. O., Akinbami F. O., Akinyinka O. O. Prognostic factors in severely malnourished hospitalized Nigerian children. Anthropometric and biochemical factors. Trop Geogr Med. 1993;45(6):290–293. [PubMed] [Google Scholar]
  10. Friedland I. R. Bacteraemia in severely malnourished children. Ann Trop Paediatr. 1992;12(4):433–440. doi: 10.1080/02724936.1992.11747610. [DOI] [PubMed] [Google Scholar]
  11. GARROW J. S., PICOU D., WATERLOW J. C. The treatment and prognosis of infantile malnutrition in Jamaican children. West Indian Med J. 1962 Dec;11:217–227. [PubMed] [Google Scholar]
  12. GOTTLIEB A., KOCHMAN R. [Hypoalbuminemia, edema & their treatment in 50 cases of malnutrition in infants]. Harefuah. 1957 Apr 15;52(8):197–197. [PubMed] [Google Scholar]
  13. Garrow J. S., Pike M. C. The short-term prognosis of severe primary infantile malnutrition. Br J Nutr. 1967;21(1):155–165. doi: 10.1079/bjn19670016. [DOI] [PubMed] [Google Scholar]
  14. Gillam S. J. Mortality risk factors in acute protein-energy malnutrition. Trop Doct. 1989 Apr;19(2):82–85. doi: 10.1177/004947558901900214. [DOI] [PubMed] [Google Scholar]
  15. Hedayat H., Gharib M., Sadre M. Protein-calorie malnutrition in hospitalized Iranian children. J Trop Pediatr (1967) 1968 Sep;14(3):124–131. doi: 10.1093/oxfordjournals.tropej.a057304. [DOI] [PubMed] [Google Scholar]
  16. Hone N. M., Fermor J. K. High-energy feeding for protein-calorie malnutrition. Results in a rural hospital in Zambia. Trop Doct. 1987 Oct;17(4):179–181. doi: 10.1177/004947558701700410. [DOI] [PubMed] [Google Scholar]
  17. Ibekwe V. E., Ashworth A. Management of protein-energy malnutrition in Nigeria: an evaluation of the regimen at the Kersey Nutrition Rehabilitation Centre, Nigeria. Trans R Soc Trop Med Hyg. 1994 Sep-Oct;88(5):594–595. doi: 10.1016/0035-9203(94)90177-5. [DOI] [PubMed] [Google Scholar]
  18. JACOBS S. I., WILLLIS A. T., LUDLAM G. B., GOODBURN G. M. Studies on newly recognised strains of Staphylococcus aureus associated with hospital infection. Lancet. 1963 May 4;1(7288):972–973. doi: 10.1016/s0140-6736(63)91752-5. [DOI] [PubMed] [Google Scholar]
  19. KAHN E. Prognostic criteria of severe protein malnutrition. Am J Clin Nutr. 1959 Mar-Apr;7(2):161–165. doi: 10.1093/ajcn/7.2.161. [DOI] [PubMed] [Google Scholar]
  20. Keet M. P., Moodie A. D., Wittmann W., Hansen J. D. Kwashiorkor: a prospective ten-year follow-up study. S Afr Med J. 1971 Dec 25;45(49):1427–1449. [PubMed] [Google Scholar]
  21. Khanum S., Ashworth A., Huttly S. R. Controlled trial of three approaches to the treatment of severe malnutrition. Lancet. 1994 Dec 24;344(8939-8940):1728–1732. doi: 10.1016/s0140-6736(94)92885-1. [DOI] [PubMed] [Google Scholar]
  22. Khanum S., Kabir I. Survival and growth of severe protein-energy-malnutrition (PEM) children 2 years after nutrition rehabilitation in an urban nutrition centre in Bangladesh. J Trop Pediatr. 1989 Jun;35(3):138–139. doi: 10.1093/tropej/35.3.138. [DOI] [PubMed] [Google Scholar]
  23. Khin-Maung-U, Nyunt-Nyunt-Wai, Myo-Khin, Myo-Min-Aung, Thaung U. Beyond rehydration therapy: non-dehydration deaths from diarrhoea in children with malnutrition. J Trop Pediatr. 1992 Oct;38(5):265–267. doi: 10.1093/tropej/38.5.265. [DOI] [PubMed] [Google Scholar]
  24. Laditan A. A., Tindimebwa G. The protein-energy malnourished child in a Nigerian teaching hospital. J Trop Pediatr. 1983 Feb;29(1):61–64. doi: 10.1093/tropej/29.1.61. [DOI] [PubMed] [Google Scholar]
  25. MCLAREN D. S., AMMOUN C., HOURI G. THE SOCIO-ECONOMIC BACKGROUND OF MARASMUS IN LEBANON. J Med Liban. 1964 Mar-Apr;17:85–96. [PubMed] [Google Scholar]
  26. MUSOKE L. K. An analysis of admissions to the Paediatric Division, Mulago Hospital in 1959. Arch Dis Child. 1961 Jun;36:305–315. doi: 10.1136/adc.36.187.305. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Mitra A. K., Khan M. R., Alam A. N. Complications and outcome of disease in patients admitted to the intensive care unit of a diarrhoeal diseases hospital in Bangladesh. Trans R Soc Trop Med Hyg. 1991 Sep-Oct;85(5):685–687. doi: 10.1016/0035-9203(91)90396-g. [DOI] [PubMed] [Google Scholar]
  28. Neave M. Protein and calorie malnutrition of early childhood in Western Samoa. Trop Geogr Med. 1968 Sep;20(3):191–201. [PubMed] [Google Scholar]
  29. Ogbeide M. I. The influence of protein-calorie malnutrition on the pattern of pre-school childhood diseases. Observations in Lagos, Nigeria. Clin Pediatr (Phila) 1968 Jul;7(7):425–431. doi: 10.1177/000992286800700717. [DOI] [PubMed] [Google Scholar]
  30. Ojofeitimi E. O., Teniola S. O. Evaluation of Nutrition Rehabilitation Centre in Ile-Ife, Oyo State, Nigeria. World Rev Nutr Diet. 1980;35:87–95. doi: 10.1159/000386407. [DOI] [PubMed] [Google Scholar]
  31. Omer H. O., Omer M. I., Khalifa O. O. Pattern of protein-energy malnutrition in Sudanese children and comparison with some other Middle East countries. J Trop Pediatr Environ Child Health. 1975 Dec;21(6):329–333. doi: 10.1093/tropej/21.6.329. [DOI] [PubMed] [Google Scholar]
  33. Pereira S. M., Begum A. The manifestations and management of severe protein-calorie malnutrition (kwashiorkor). World Rev Nutr Diet. 1974;19:1–50. doi: 10.1159/000394763. [DOI] [PubMed] [Google Scholar]
  34. Ramdath D. D., Golden M. H. Elevated glutathione S-transferase activity in erythrocytes from malnourished children. Eur J Clin Nutr. 1993 Sep;47(9):658–665. [PubMed] [Google Scholar]
  35. Ramprasad V., Williams V. W. Nutrition education through nutrition rehabilitation. J Trop Pediatr. 1980 Jun;26(3):123–126. doi: 10.1093/tropej/26.3.123. [DOI] [PubMed] [Google Scholar]
  36. Reeds P. J., Laditan A. A. Serum albumin and transferrin protein-energy malnutrition. Their use in the assessment of marginal undernutrition and the prognosis of severe undernutrition. Br J Nutr. 1976 Sep;36(2):255–263. doi: 10.1079/bjn19760077. [DOI] [PubMed] [Google Scholar]
  37. SCRAGG J., RUBIDGE C. Kwashiorkor in African children in Durban. Br Med J. 1960 Dec 17;2(5215):1759–1766. doi: 10.1136/bmj.2.5215.1759. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Sadre M., Donoso G. Treatment of malnutrition. Lancet. 1969 Jul 12;2(7611):112–112. doi: 10.1016/s0140-6736(69)92430-1. [DOI] [PubMed] [Google Scholar]
  39. Sadre M., Hedayat H., Gharib M., Ghavam Z., Donoso G. Dehydration syndrome in malnourished Iranian children. Am J Clin Nutr. 1969 Feb;22(2):139–146. doi: 10.1093/ajcn/22.2.139. [DOI] [PubMed] [Google Scholar]
  40. Smith I. F., Taiwo O., Golden M. H. Plant protein rehabilitation diets and iron supplementation of the protein-energy malnourished child. Eur J Clin Nutr. 1989 Nov;43(11):763–768. [PubMed] [Google Scholar]
  41. YAROM R., MCFIE J. KWASHIORKOR IN THE CONGO. (A CLINICAL SURVEY OF A HUNDRED SUCCESSIVE CASES IN THE KASAI PROVINCE). J Trop Pediatr Afr Child Health. 1963 Sep;9:56–63. [PubMed] [Google Scholar]
  42. van Roosmalen-Wiebenga M. W., Kusin J. A., de With C. Nutrition rehabilitation in hospital--a waste of time and money? Evaluation of nutrition rehabilitation in a rural district hospital in South-west Tanzania. II. Long-term results. J Trop Pediatr. 1987 Feb;33(1):24–28. doi: 10.1093/tropej/33.1.24. [DOI] [PubMed] [Google Scholar]

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