[Protein-energy malnutrition in an urban African milieu (Togo). Etiologic factors in kwashiorkor and marasmus-kwashiorkor].

The etiologic factors of protein-energy malnutrition (P.E.M.) have been studied in 59 children with kwashiorkor (KWK) or marasmus-kwashiorkor (MKWK) and living in an african urban area. The decline of breast feeding leads to an earlier P.E.M., mainly MKWK. This decline is linked to urbanization, mother's activities, dislocation of traditional structures and use of artificial formulas. Essentially based on cereals, the diet is responsible of the post-weaning P.E.M. Poverty, ignorance and food taboos are related to a lack in weaning food varieties. A small number of infants with KWK had a rich protein diet putting back the cause of an hypoproteic diet on the KWK onset. Infections play a determinant role in the onset of KWK and of some MKWK, after 2 years of age. Diarrhoea, measles, bronchopulmonary and parasitic diseases are the most prevalent infections. Among socio-cultural factors, conjugal disorders are predominating with child-mother break-up and father's bonding failure. At the opposite of rural areas, the family size is reduced. The three first birth ranges are specially concerned with young inexperienced mothers.