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East Afr Med J. 1994 Apr;71(4):264-7.

Clinical profile and pattern of infection in Ethiopian children with severe protein-energy malnutrition.

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  • 1Department of Paediatrics and Child Health, Faculty of Medicine, Addis Ababa University, Ethiopia.


The results of a prospective study on the clinical profile and pattern of infection in 90 Ethiopian children with severe protein-energy malnutrition (PEM) is presented. The study group consisted of 44(49%) with marasmus, 29(32%) with marasmic-kwashiorkor and 17(19%) with kwashiorkor. Their age ranged from 4 to 60 months and the median age at admission was 11.5, 15 and 20 months, respectively. Over 80% of the patients were infected and the lungs were the commonest sites. Bacterial pathogens, predominantly Gram negative enteric organisms, were isolated from 36% of blood and 37% of urine specimens. Tuberculosis and non-typhoidal salmonellae showed a higher tendency of causing disseminated disease. Rickets and overt vitamin A deficiency were seen in 37% and 17% of the patients, respectively. Septicaemia, gastroenteritis, pneumonia and disseminated tuberculosis accounted for an overall case fatality rate of 32%. Mortality was higher in children with total serum protein of 5gm% or less. The clinical profile and the pattern of infection varied from observations made elsewhere in developing countries which also showed discrepant results. More comprehensive and carefully designed work is proposed to elucidate the clinical and geographic heterogeneity of severe PEM.


A prospective study of 90 children admitted to Ethio-Swedish Children's Hospital in Addis Ababa, Ethiopia, in 1992 with severe protein-energy malnutrition assessed the clinical profile and patterns of infection. The children, who ranged in age from 4 to 60 months, suffered from marasmus (49%), marasmic-kwashiorkor (42%), and kwashiorkor (19%). Septicemia, the most alarming complication of severe protein-energy malnutrition, was present in 32 children (36%); gram-negative enteric bacilli were the most common bacterial pathogen. 57 children (63%) had pneumonia and 23 (26%) had tuberculosis. Another 33 (37%) had a urinary tract infection. 17 children (19%) presented with diarrhea, 33 (37%) had clinical and radiologic evidence of rickets, and 15 (17%) had clinical evidence of vitamin A deficiency. There were 29 deaths in this series (from septicemia, gastroenteritis, pneumonia, and disseminated tuberculosis), for a case fatality rate of 32%. Mortality was significantly greater among children with a total serum protein of 5 gm% or less and those with systemic infection. This profile differs from those recorded in other developing countries, suggesting that severe protein-energy malnutrition has clinical and geographic heterogeneity.

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