GULU UNIVERSITY MEDICAL JOURNAL

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Gulu University Medical Journal (GUMJ) 2009/2010 Vol 5. Although disease centered treatment and prevention programs can positively affect nutritional status, preventing malnutrition in children is essential to reduce significantly child mortality. Thus the first step in preventing child death is to make sure that every child is well nourished References Black RE, Morris SS & Bryice J, (2003). Where and Why are 10 million children dying every year? Lancet 361:2226- 2234 Ezzati M, Lopez AD, Rodgers A, Vander HS & Murray CJ (2002). The Comparative Risk Assessment Collaborating Group: Selected major risk factors and global and regional burden of disease. Lancet 360: 1347-1360 Food and Agricultural Organization (2005). The State of Food Insecurity in the World: Eradicating world hunger key to achieving the Millennium Development Goals. Rome, Italy Pelletier DL, (1994). The relationship between child anthropometry and mortality in developing countries: implications for policy, programs and future research. Journal of Nutrition; 124: 2047S–2081S. Pelletier DL et al., (1995). The effects of malnutrition on child mortality in developing countries. Bulletin of the World Health Organization, 73: 443–448 Pelletier DL, Frongillo EA Jr., Habicht JP, (1994). A methodology for estimating the contribution of malnutrition to child mortality in developing countries, The Journal of Nutrition, Supplement, 124 (10S): 2106S-2122S, Pelletier DL & Frongillo EA, (2003). Changes in Child Survival are Strongly Associated with Changes in Malnutrition in Developing Countries. Journal of Nutrition 133:107-119. Schofield C & Ashworth A, (1996). Why have mortality rates for severe malnutrition remained so high? Bulletin of the World Health Organization, 74: 223–229. Schroeder DG & Brown KH, (1994). Nutritional status as a predictor of child survival: summarizing the association and quantifying its global impact. Bulletin of the World Health Organization, 72: 569–579. UNICEF (1998). The State of the World’s Children 1998. New York: Oxford University Press. United Nations (UN) Administrative Committee on Coordination, SCN. The 5th Global Nutrition Report. Geneva: UN System Standing Committee for Nutrition, 2004. World Health Organization, 2008. The state of the world’s children 2008: Child survival. Geneva, WHO Gulu University Medical Students’ Association (GUMSA) Passion for life 12
Gulu University Medical Journal (GUMJ) 2009/2010 Vol 5. Malnutrition: A main cause of children’s death! Luigi Greco, M.Sc. (MCH), M.D., D.C.H., PhD (Hon) Department of Pediatrics, University of Naples Federico II and European Laboratory for Food Induced Disease Valentina Fiorito, M.D. Department of Pediatrics, University of Naples Federico II Malnutrition is one of the greatest public health problems facing the world today because of the number of children affected and the long-term consequences. The World Health Organization (WHO) estimates that malnutrition contributes to 53% of child mortality worldwide (1-2). There is a strong association between malnutrition and mortality in developing countries because even mild degrees of malnutrition double the risk of mortality for other diseases such as respiratory tract infection, diarrhoea, pneumonia, malaria and measles (3-4) (Figure 1). Table I shows how WHO defines a patient’s nutritional status. Mild Acute Malnutrition benefits of health counselling and community mobilization. Moderate Acute Malnutrition is still manageable in community setting but needs a specific program: Supplementary Feeding Program (SFP). This program is based on Supplementary Feeding Centres (SFC) that monitor every week the patient and provide antibiotics, antihelminthics, vitamin A and high energy fortified supplementary food like Ready–to-Use Therapeutic Food (RUFT). Severely malnourished children and infants less then 6 months old with specific features (Wt < 4Kg, Wt/ Length< 85% and not able to suckle/not fed on breast-milk, mother died or mother has no or little milk or presence of oedema) have to be admitted in a Therapeutic Feeding Centre (TFC). In this centre they are managed, according to a specific Therapeutic Feeding Program (TFP). Almost all severely malnourished children have infections, impaired liver and intestinal function, and problems related to imbalance of electrolytes when first admitted to hospital. Because of these problems, they are unable to tolerate the usual amounts of dietary protein, fat and sodium. It is important, therefore, that children begin feeding on a diet that is low in these nutrients, and high in carbohydrate. To this purpose UNICEF and WHO prepared two formula diets based on the Modified Cow’s Milk F75 (starter 75 KCal/100 ml) and F100 (follow up 100 KCal/100ml). These milks are given, in proportion of the body weight, at 3 hourly intervals. F75 has a moderate protein and energy content and is given in the early phase of severe malnutrition, F100 has a higher energy and protein content and is useful for maintenance. The milks have to be given frequently and in small amounts to avoid overloading the intestine, liver and kidneys. Children unable to drink are fed by plastic syringes and nasogastric tube. The theoretical daily supply of energy is 140 to 200 Calories/kg body weight. But this amount is very difficult to administer to any single child. Night feeds are generally not available. Table II shows the composition of the two milk feeds: F75 starter, to be given for the first few days and F100 for follow up. From the table is clear that the feeds are based on skimmed milk with added sugar and vegetable oil. The mineral mix with potassium, magnesium and other essential minerals must be added to the diet. The potassium deficit, present in all malnourished children, adversely affects cardiac function and gastric emptying. Magnesium is essential for potassium to enter cells and be retained. The mineral mix does not contain iron as this is withheld during the initial phase. Unfortunately about 95.4% of African children have the C/C- 13910 genotype of the lactase-Y-phlorizin- hydrolase gene that causes adult-type hypolactasia (vs 14.5% of Finnish children). The decline of the lactase activity in African children occurred earlier than Finnish children, as 30% of the children already had low levels of lactase (< 10 U/g protein) at the age of five years (9). Gulu University Medical Students’ Association (GUMSA) Passion for life 13
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