An infant with kwashiorkor: The forgotten disease

Introduction Undernutrition remains a major public health concern, especially in developing regions such as Africa, in which three million children under the age of five die each year, constituting nearly half of global deaths in that category.1 Undernourished infants and young children are at a greater risk of dying from common infections, as undernutrition not only increases the severity and frequency of such infections but also delays recovery.1 Malaysia, a country that is rich with resources, simultaneously faces crises of overnutrition and undernutrition. Other physical findings of kwashiorkor may include rounded cheeks, pursed lips, dry peeling skin, sparse hair, hepatomegaly, bradycardia, and hypotension.3,5,10 The differential diagnosis of kwashiorkor in children includes congenital cardiac failure, glomerulonephritis, nephrotic syndrome, hepatic cirrhosis, hemolytic anemia, and protein-losing enteropathy.3,4 Kwashiorkor cases are difficult to diagnose and in turn, are often overlooked. The World Health Organization has developed a strategy for reducing mortality and morbidity associated with major causes of childhood illness called Integrated Management of Childhood Illnesses;13 this is an integrated approach that addresses the overall health of a child, including nutritional status. In developing countries, the mainstay of dietary therapy for kwashiorkor involves cow's milk.6 While treating kwashiorkor, professionals should keep refeeding syndrome in mind, as it is a potentially lethal condition that can result from nutritional support.9 The World Health Organization has formulated a three-phase management approach for severely malnourished children in which they are 1) resuscitated and stabilized, 2) started on nutritional rehabilitation, and 3) followed up on for recurrence prevention.15 Conclusion Undernourished infants and children are not uncommon in primary care.