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

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.