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Primary PEM:
Protein + energy intakes below requirement for normal growth.
Secondary PEM:
the need for growth is greater than can be supplied.
decreased nutrient absorption
increase nutrient losses
Static weight
Weight loss
Wasting
• Protein-energy
malnutrition caused
0.46% of all deaths
worldwide in 2002, an
average of 42 deaths
per million people per
year.
Urban 36.4
Rural 49.0
1. Kwashiorkor
2. Marasmic-kwashiorkor
3. Marasmus
4. Nutritional dwarfing
5. Underweight child
Marasmic < 60 + ++
kwashiorkor
Marasmus < 60 0 ++
The child looks appallingly thin and
limbs appear as skin and bone
Shriveled body
Wrinkled skin
Bony prominence
Associated vitamin deficiencies
Failure to thrive
Irritability, fretfulness and apathy
Frequent watery diarrhoea and acid
stools
Mostly hungry but some are
anoretic
Dehydration
Temperature is subnormal
Muscles are weak
Oedema and fatty infiltration are
absent
St.Ann's Degree College for Women
DIFFERENCE IN CLINICAL FEATURES
BETWEEN MARASMUS AND
KWASHIORKOR
May be masked by
-WEIGHT FOR Very low edema
HEIGHT
Irritable, moaning,
-MENTAL Sometimes quite and apathetic
CHANGES apathetic
St.Ann's Degree College for Women
DIFFERENCE IN CLINICAL FEATURES BETWEEN MARASMUS AND KWASHIORKOR
1. Hospital Treatment
The following conditions should be corrected.
Hypothermia, hypoglycemia, infection, dehydration, electrolyte
imbalance, anaemia and other vitamin and mineral deficiencies.
2. Dietary Management
The diet should be from locally available staple foods - inexpensive, easily
digestible, evenly distributed throughout the day and increased number of
feedings to increase the quantity of food.
3. Rehabilitation
The concept of nutritional rehabilitation is based on practical nutritional training
for mothers in which they learn by feeding their children back to health under
supervision and using local foods.
St.Ann's Degree College for Women
PREVENTION