Community Health science

Kwashiorkor is a severe form of protein–energy malnutrition that occurs mainly in children, usually after early weaning from breast milk and replacement with foods that are high in carbohydrates but very low in protein.
The word Kwashiorkor comes from a Ghanaian language meaning “the sickness the child gets when a new baby comes”, because the older child is often deprived of breast milk.

Causes of Kwashiorkor
Severe protein deficiency
Early cessation of breastfeeding
Diet mainly made of cassava, rice, maize, or gari without protein
Poverty and food insecurity
Recurrent infections (diarrhea, measles, malaria)
Poor maternal nutrition
Poor health education

Pathophysiology (What happens in the body)
Lack of protein → ↓ albumin in blood
Low albumin → fluid leaks into tissues
This causes edema (swelling)
Liver cannot process fat → fatty liver
Immune system weakens → frequent infections

Signs and Symptoms of Kwashiorkor
General signs
Bilateral pitting edema (feet, legs, face)
Distended abdomen (“pot belly”)
Growth failure
Muscle wasting (hidden by edema)

Skin changes
Dark or pale patches
Peeling skin (“flaky paint dermatitis”)
Depigmentation
Hair changes
Hair becomes thin, dry, reddish or yellowish
Hair easily falls out
“Flag sign” (alternating dark and light bands)
Systemic features
Apathy, irritability
Anemia
Fatty liver (hepatomegaly)
Diarrhea
Poor appetite
Delayed wound healing

Diagnosis
Clinical signs (edema, skin & hair changes)
Weight-for-height assessment
Low serum albumin (if lab available)
History of poor protein intake

Management of Kwashiorkor
Immediate management
Treat hypoglycemia
Treat hypothermia
Manage dehydration carefully
Treat infections (antibiotics)
Correct electrolyte imbalance

Nutritional rehabilitation
Start with F-75 therapeutic milk
Progress to F-100
Introduce high-protein foods gradually:
Eggs
Beans
Fish
Groundnuts
Milk
Micronutrients
Vitamin A
Zinc
Iron (after stabilization)
Folic acid

Prevention of Kwashiorkor
Exclusive breastfeeding