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Kwashiorkor in an Exclusive Breastfed Infant in a Sri Lanka

Received: 4 October 2022    Accepted: 1 November 2022    Published: 31 July 2023
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Abstract

Protein energy malnutrition is a common problem in developing countries rather than developed countries. Protein energy malnutrition is mainly divided into two groups, such as acute protein energy malnutrition and chronic protein energy malnutrition. In acute protein energy malnutrition mainly decreased weight gain with normal linear growth resulting in wasting. But in chronic protein energy malnutrition both weight and height will be affected, and it may cause reduction of linear growth in leading to stunting. The World Health Organization (WHO) and UNICEF recommend in using weight for height to detect acute malnutrition and if a weight for height is less than -3 standard deviation it classified as severe acute malnutrition. WHO also recommended using mid upper arm circumference to assess severe acute malnutrition and cut off point taken as 110-115mm. Protein energy malnutrition can occur in any condition in which there is severe restraint of caloric intake. Additional reasons are increased requirements, poor absorption, impaired utilization, or excessive loss of nutrients. Severe acute malnutrition can be divided in to two, based on a clinical feature such as if present with pitting edema, and fatty liver called kwashiorkor, and if not, called marasmus. Our patient was five months old, an exclusively breast-fed child presented severe acute malnutrition with features of kwashiorkor from a very poor socio-economic background. We were able to manage the child with available resources without any complications.

Published in American Journal of Pediatrics (Volume 9, Issue 3)
DOI 10.11648/j.ajp.20230903.16
Page(s) 137-139
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Severe Acute Malnutrition (SAM), Kwashiorkor, Exclusively Breast Feeding, Sri Lanka

References
[1] Black R et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet, 2013; 382: 427–51.
[2] World Health Organization and the United Nations Children’s Fund. WHO child growth standards and the identification of severe acute malnutrition in infants and children. A Joint statement. 2009. Accessed July 12, 2020. http://www.who.int/maternal_child_adolescent/documents/9789241598163/en/
[3] United Nations Interagency Group for Child Mortality Estimation. Levels and trends in child mortality. Report 2012. New York, United Nations Children’s Fund, 2012.
[4] Fitzpatrick M, Ghosh S, Kurpad A, Duggan C, Maxwell D. Lost in Aggregation: The Geographic Distribution of Kwashiorkor in Eastern Democratic Republic of the Congo. Food Nutr Bull. 2018 Dec; 39 (4): 512-520.
[5] Fitzpatrick, Merry; Ghosh, Shibani et al. Lost in aggregation: The Geographic Distribution of Kwashiorkor in Estern Democretic Republic of the Congo. Food and Nutrition Bulletin, 2018 (1-9) 037957211879407. doi. 1177/037957211879407.
[6] M Mei-Zahav, M Solomon et al, Cystic fibrosis presenting as kwashiorkor in a Sri Lankan infant, Arch Dis Child 2003; 88: 724–725.
[7] Ali, S. M. Meshram, et al. A hospital-based study of severe acute malnutrition in infants less than six months and comparison with severe acute malnutrition in children 6–60 months. Sri Lanka Journal of Child Health, 2017; 46 (3): 234–237.
[8] World Health Organization, United Nations Children’s Fund. WHO Child Growth Standards and the Identification of Severe Acute Malnutrition in Infants and Children. Geneva, Switzerland: World Health Organization, United Nations Children’s Fund; 2009.
[9] Bahwere P, Binns P, Collins S. Community-Based Therapeutic Care (CTC): A Field Manual 1st ed. Oxford, United Kingdom: Valid International; 2006.
[10] Alvarez JL, Dent N, Browne L, Myatt M, Briend A. Putting child kwashiorkor on the map. CMAM Forum Technical Brief. 2016.
[11] Vijayalakshmi Eruva et al Early Diagnosis of Kwashiorkor and Its Successful Treatment in Urban Ludhiana, Journal of medical science and clinical research, 2017; 05: 21040-41.
[12] Sarah Bunker, Jyotsna Pandey. Educational Case: Understanding Kwashiorkor and Marasmus: Disease Mechanisms and Pathologic Consequences, Academic Pathology: Volume 8 DOI: 10.1177/23742895211037027 journals.sagepub.com/home/apc ª The Author(s) 2021.
[13] MacDonald J Ndeka (2008). Kwashiorkor and severe acute malnutrition in childhood, 371 (9626), 1-doi: 10.1016/s0140-6736(08)60756-7.
[14] Ahmed S, Ejaz K, Mehnaz A, Adil F. Implementing WHO feeding guidelines for inpatient management of malnourished children. J Coll Physicians Surg Pak. 2014 Jul; 24 (7): 493-7.
[15] Management of severe Acute undernutrition, Manual for Health Workers in Sri Lanka, Ministry of Healthcare and Nutrrition Sri Lanka in collaboration with UNICEF 2007.
Cite This Article
  • APA Style

    Manori Priyadarhani, Jeewana Prasad, Asanka Alexander, Hemali De Silva, Perly Gamage. (2023). Kwashiorkor in an Exclusive Breastfed Infant in a Sri Lanka. American Journal of Pediatrics, 9(3), 137-139. https://doi.org/10.11648/j.ajp.20230903.16

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    ACS Style

    Manori Priyadarhani; Jeewana Prasad; Asanka Alexander; Hemali De Silva; Perly Gamage. Kwashiorkor in an Exclusive Breastfed Infant in a Sri Lanka. Am. J. Pediatr. 2023, 9(3), 137-139. doi: 10.11648/j.ajp.20230903.16

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    AMA Style

    Manori Priyadarhani, Jeewana Prasad, Asanka Alexander, Hemali De Silva, Perly Gamage. Kwashiorkor in an Exclusive Breastfed Infant in a Sri Lanka. Am J Pediatr. 2023;9(3):137-139. doi: 10.11648/j.ajp.20230903.16

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  • @article{10.11648/j.ajp.20230903.16,
      author = {Manori Priyadarhani and Jeewana Prasad and Asanka Alexander and Hemali De Silva and Perly Gamage},
      title = {Kwashiorkor in an Exclusive Breastfed Infant in a Sri Lanka},
      journal = {American Journal of Pediatrics},
      volume = {9},
      number = {3},
      pages = {137-139},
      doi = {10.11648/j.ajp.20230903.16},
      url = {https://doi.org/10.11648/j.ajp.20230903.16},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20230903.16},
      abstract = {Protein energy malnutrition is a common problem in developing countries rather than developed countries. Protein energy malnutrition is mainly divided into two groups, such as acute protein energy malnutrition and chronic protein energy malnutrition. In acute protein energy malnutrition mainly decreased weight gain with normal linear growth resulting in wasting. But in chronic protein energy malnutrition both weight and height will be affected, and it may cause reduction of linear growth in leading to stunting. The World Health Organization (WHO) and UNICEF recommend in using weight for height to detect acute malnutrition and if a weight for height is less than -3 standard deviation it classified as severe acute malnutrition. WHO also recommended using mid upper arm circumference to assess severe acute malnutrition and cut off point taken as 110-115mm. Protein energy malnutrition can occur in any condition in which there is severe restraint of caloric intake. Additional reasons are increased requirements, poor absorption, impaired utilization, or excessive loss of nutrients. Severe acute malnutrition can be divided in to two, based on a clinical feature such as if present with pitting edema, and fatty liver called kwashiorkor, and if not, called marasmus. Our patient was five months old, an exclusively breast-fed child presented severe acute malnutrition with features of kwashiorkor from a very poor socio-economic background. We were able to manage the child with available resources without any complications.},
     year = {2023}
    }
    

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  • TY  - JOUR
    T1  - Kwashiorkor in an Exclusive Breastfed Infant in a Sri Lanka
    AU  - Manori Priyadarhani
    AU  - Jeewana Prasad
    AU  - Asanka Alexander
    AU  - Hemali De Silva
    AU  - Perly Gamage
    Y1  - 2023/07/31
    PY  - 2023
    N1  - https://doi.org/10.11648/j.ajp.20230903.16
    DO  - 10.11648/j.ajp.20230903.16
    T2  - American Journal of Pediatrics
    JF  - American Journal of Pediatrics
    JO  - American Journal of Pediatrics
    SP  - 137
    EP  - 139
    PB  - Science Publishing Group
    SN  - 2472-0909
    UR  - https://doi.org/10.11648/j.ajp.20230903.16
    AB  - Protein energy malnutrition is a common problem in developing countries rather than developed countries. Protein energy malnutrition is mainly divided into two groups, such as acute protein energy malnutrition and chronic protein energy malnutrition. In acute protein energy malnutrition mainly decreased weight gain with normal linear growth resulting in wasting. But in chronic protein energy malnutrition both weight and height will be affected, and it may cause reduction of linear growth in leading to stunting. The World Health Organization (WHO) and UNICEF recommend in using weight for height to detect acute malnutrition and if a weight for height is less than -3 standard deviation it classified as severe acute malnutrition. WHO also recommended using mid upper arm circumference to assess severe acute malnutrition and cut off point taken as 110-115mm. Protein energy malnutrition can occur in any condition in which there is severe restraint of caloric intake. Additional reasons are increased requirements, poor absorption, impaired utilization, or excessive loss of nutrients. Severe acute malnutrition can be divided in to two, based on a clinical feature such as if present with pitting edema, and fatty liver called kwashiorkor, and if not, called marasmus. Our patient was five months old, an exclusively breast-fed child presented severe acute malnutrition with features of kwashiorkor from a very poor socio-economic background. We were able to manage the child with available resources without any complications.
    VL  - 9
    IS  - 3
    ER  - 

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Author Information
  • General Paediatric Ward, Teaching Hospital Karapitiya, Galle, Sri Lanka

  • General Paediatric Ward, Teaching Hospital Karapitiya, Galle, Sri Lanka

  • General Paediatric Ward, Teaching Hospital Karapitiya, Galle, Sri Lanka

  • General Paediatric Ward, Teaching Hospital Karapitiya, Galle, Sri Lanka

  • Nutrition Clinic, Teaching Hospital Karapitiya, Galle, Sri Lanka

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