The deficiency of any of the essential constituents of good leads to malnutrition. This in turn leads to specific diseases. Various diseases caused by the deficiency of vitamins and minerals has already been discussed. Two important diseases are caused due to protein energy malnutrition (PEM) in children They are 1. Kwashiorkar 2. Marasmus.
Protein energy malnutrition (PEM)
It is also called as protein – calorie malnutrition. It is a major health and nutrition problem in india. It occurs particularly in weanlings and children in the first year life. The two clinical forms of PEM are Kwashiorkar and Marasmus.
This forms of PEM occurs mostly in the second year of life. It is due to weaning of the child from breast to a diet law in protein. So the essential feature is a deficiency of protein with adequate energy intake.
The child is not very thin. There is generalised edema. The child is miserable and a pathetic with a characteristic mewing cry. The skin changes may very form pigmentation, thickening and cracks to unceration. Hair is thin and sparse and colour is reddish or grey. There may be angular stomatitis. Also diarrhea is common.
It consists of
- Resuscitation by correcting dehydration and hypoglycemia.
- Treatment by weaning foods and vitamins.
- Rehabilitation in nutrition. centers
- Education of mothers about nutrition.
- Supplementation of diet provide in nutrition centers like ICDS.
- Encouraging the use of locally available diet.
The incidence of marasmus is high when compared to Kwashiorkar. It occurs in the second six months of life. It occurs due to a diet very low in both protein and calories.
The child is weaned early and fed with very dilute cow’s milk. The may go to work leaving the baby with old grandmother, sister or neighbour. So the child is not properly cared and fed. Also diarrhoea occurs due to poor hygiene.
The child is very thin with no subcutaneous fat. Muscles are severely wasted. Head is large for the body. Ribs are protruding and abdomen is distended. Limbs look like sticks and buttocks are boggy. Unlike Kwashiorkar, there is no oedema and hair changes. Weight of the child is reduced below 60 per cent. There is diarrhea, dehydration and vitamin deficiency.
Management of marasmus is the same as for kwashiorkar.
- Family planning to restrict the number of children.
- Immunisation of children.
- Encouraging breast feeding.
- Attending maternity and child health clinics as also ICDS centers.