Protein energy malnutrition (PEM)
The term PEM is a broad term referring to a group of
disorders related to inadequate intake of protein and carbohydrates.
There are 3 forms of PEM which include;
- Kwashiorkor
(protein deficiency); characterized by tissues oedema and damage.
- Marasmus
(protein and calorie deficiency); characterized by growth failure and wasting.
- Marasmic
kwashiorkor; the combination of kwashiorkor and marasmus.
KWASHIORKOR
Kwashiorkor is a disease caused by protein deficiency when
the weaned child is given only starchy foods but low' or no protein diet. It is
a Ga work describing the condition the older gets when next baby is born. A
paediatrician by name Cicely Williams in 1933 introduced this term into
medicine.
Causes
- Poverty
- Poor food
choices
- Infections
- Ignorance
- Impaired
digestive & absorption of nutrition
- Insufficient
dietary intake
- Poor family
planning
Signs and Symptoms
- Diminished
adipose tissue
- Oedema of
legs, arms and face
- Misery and
apathy
- Alopecia
- Moon face
appearance
- Lack of
appetite
- Enlarged
liver
- Muscle
wasting
- Muscle
wasting
- Dry peeling
skin
- Diarrhea
MARASMUS
Lack of both protein and carbohydrates (calorie) which is
characterized by extreme wasting. The term marasmus come from Greek word
‘marasoms’ meaning wasting.
Causes
- Poverty
- Wars
- Natural
disaster
- Bottle
feeding
- Breast
disease
- Failure of
breastfeeding
- Infections
Signs and Symptoms
- Old man’s
face
- Extreme
wasting
- Pot belly
- Irritability
- Sparse, dull
hair
- Good
appetite
- Diarrhea
- Oedema is
absent
- Red swollen
lips
- Growth
retardation
- Extremely low weight
Diagnosis of PEM
- Weight -for
-age
- Presence or
absence of oedema
- If the child's weight is 60-80% of the standard weight with
oedema, then it’s kwashiorkor.
- If the child’s weight is < 60% of standard with no
oedema, then it’s marasmus.
Treatment for PEM
- The aim of
treatment is to provide proteins, calories and other nutritional elements’
- If there is
secondary bacterial infection like gastro - enteritis, you treat with
appropriate antibiotics
- Assist
patients to eat, if necessary
- Provide skin
care & ensure that patient does not develop bed sores.
- Encourage
prolong breastfeeding
- Educate
family about family planning
- Give small,
frequent meals
- You must
ensure that child receives love, attention and affection from parents.
- Refer child
to a nutritional rehabilitation center if there is no improvement
Prevention
- Health education
on nutrition
- Establishment
of nutritional rehabilitation centers
- Health
education on family planning
- Health
education on immunization
- Government
intervention
Complications
- Anaemia
- Dehydration
- Mental retardation
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