The social, family and medical backgrounds of children with kwashiorkor presenting at a teaching hospital
The social, fanilly and medical backgrounds of 53 children hospitalised with kwashiorkor were Compared with those of 106 children hospitalised for non-nutritional diseases to determine risk factors for severe nutritional disease in children presenting to a teaching hospital. The control children were matched for age, sex, race and the nonnutritional illness complicating the course of the children with kwashiorkor; in 80% of cases the reason for admission was either gastro-enteritis or pneumonia. A major difference between the groups was the educational status of the mothers. Only 57% of the mothers of the children with kwashiorkor were literate compared with 93% of the controls; 25% as opposed to 47% were married, and 36% as opposed to 72% received support from the father. There were no differences in the mothers' ages or use of contraception, or in the number of children they had. In all except 1 instance the child with kwashiorkor was the youngest or only child in the family, and the average sibling interval was 53 months. The types of dwellings occupied by the families were similar, but overcrowding was worse in the kwashiorkor group. Family income was below the household subsistence level in the vast majority of both groups, but significantly more of the kwashiorkor group had minimal cash income. Significantly fewer of the children with kwashiorkor had been breast-fed or adequately immunised, and 60% had previously been hospitalised for dehydrating diarrhoea. This study demonstrates that in an urban environInent the traditional factors of large families and displacement by a younger sibling are not associated with kwashiorkor. However, children likely to develop kwashiorkor can readily be identified for inclusion in nutritional prograInInes.
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