WHAT IS KWARSHIORKOR?

WHAT IS KWARSHIORKOR?. Kwashiorkor, the other major PEM, may require an equally difficult treatment program. Kwashiorkor is a disease of protein malnutrition that usually occurs in poor countries, especially during times of drought, famine, or war. The rare cases of kwashiorkor in wealthy countries are almost always due to child abuse. However, it also is sometimes a problem among institutionalized,disabled adults, such as elderly people confined to nursing homes.

Kwashiorkor is a term from the African language of Ga. It means “the evil spirit that infects the first child when the second child is born.” The name accurately reflects both the age at which kwashiorkor most typically begins (between 1 and 3 years) and the most common trigger of the disease. When a second child is born,the mother stops breastfeeding the first in favor of the newborn infant.

The toddler is thus deprived of the protein in the mother’s milk. Usually, the weaned child is then fed an extremely poor diet. Although calories are adequate, they are almost exclusively from carbohydrates, such as rice, corn, yams, or cassava; the child receives little or no protein. As might be expected from such a diet, the child with kwashiorkor suffers deficiencies in vitamin A, vitamin C, and the B vitamins, as well as in iron and iodine. It is theorized that a lack of essential fatty acids also plays a role, and some researchers suspect that moldy foods, which are common in tropical countries, might be an important factor. The toxins from mold have to be detoxified by the liver, and too much toxic overload can damage the liver. Children with kwashiorkor always have damaged livers. Most of these children also have parasitic,viral, or bacterial infections, as well as chronic diarrhea

All of the symptoms of kwashiorkor occur because the body is missing the essential amino acids that are the building blocks it needs for maintaining body structure and function. The defining symptom of kwashiorkor is edema: an accumulation of fluids in the body. The child with kwashiorkor does not appear emaciated, but swollen. The edema usually starts in the feet and ankles and then spreads as the disease progresses.

A child with severe kwashiorkor has a swollen belly, puffy cheeks, and swollen hands. Other symptoms include lethargy, fatigue, muscle wasting, flaking skin, and thin, reddish, brittle hair. The child fails to grow and is seriously underweight, although the edema can hide the problem. He or she also is irritable, lifeless, and loses appetite. Kwashiorkor puts a child in serious danger of death: About 4 of every 10 children with this disease will die of it. Once the disease becomes severe, it is difficult to treat. Even when treatment is successful, the child will never achieve his or her full height.

As with marasmus, treatment begins with rehydration, treatment of infection, restoration of electrolyte balance, vitamin and mineral supplements, and slow feeding. Too much protein cannot be given right away, or the liver might be overloaded and permanently damaged. When kwashiorkor was first recognized as a disease during the 1930s, the death rate was 90%, even among hospitalized children. These deaths often occurred because the victims had metabolisms that were adapted to a starvation diet. When the children were suddenly given lots of healthy food, they could not metabolize it. Instead, they went into shock, suffered from liver failure and kidney failure, and died from heart failure.

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