Progress in the Treatment of Protein–Energy Malnutrition

In some hospitals many children with protein-energy malnutrition (PEM) die within a few days of admission, and it is unfortunate that some of these hospital deaths are the result of inadequate or misguided medical treatment.In our Unit in Jamaica few children die and the mortality rate has rarely exceeded 5%.Elsewhere in Jamaica, although the severity of malnutrition is very uniform, mortality from PEM can vary from 5 to 50% depending on the hospital.Mortality rates of up to 50% have also been reported from hospitals in other countries, and it is therefore not surprising that some people question whether a hospital is the right place in which to treat PEM (Cook, 1971;Koppert, 1977).There are, however, hospitals with excellent records of low mortality and in each case the basic principles of treatment are similar and are based on a fundamental understanding of the physiological and biochemical changes which occur in PEM (Nichols et al. 1974; Suskind, 1975).In addition to mortality being unnecessarily high it is also regrettable that recovery from PEM is often distressingly slow, and a better understanding of the nutritional requirements for 'catch-up' growth would greatly improve the efficiency of treatment in both hospitals and nutrition rehabilitation centres.We find in our Unit, for example, that the weight deficits of even the most-severely-malnourished children can be corrected in 4-6 weeks, which is in marked contrast to the prolonged periods sometimes reported (Bengoa, 1976).The treatment of children with PEM can be divided as follows:(I) acute phase (a) resuscitation, (b) initiation of cure;(2) rehabilitation phase (a) catch-up growth, (b) transfer to 'family-type' diet.Children are most at risk in the acute phase and therefore treatment during this period is best carried out in hospital.The second phase of rehabilitation carries little risk, and an alternative location for treatment could be a nutrition rehabilitation centre. Acute phase (a) ResuscitationMalnourished children who are critically ill need urgent attention.Dehydration, infection and occasionally severe anaemia are the main conditions threatening life.Setme dehydration.Diarrhoea or vomiting or both can lead to Severe dehydration which is a serious condition best remedied by intravenous therapy..