Kwashiorkor is a condition caused by extreme protein deficiency and characterized by swelling in both extremities.

Kwashiorkor usually happens to children, especially in developing countries where there is a lot of poverty and not enough food. Southeast Asia, Central America, the Congo, Puerto Rico, Jamaica, South Africa, and Uganda are some of the most affected places in the world.

Many researchers believe protein deficiency causes Kwashiorkor but it may only be a part of the reason since some patients of this condition do not respond to an increase in dietary protein.

One of the causes of Kwashiorkor includes having a carbohydrate-heavy diet. Due to a lack of resources or nutrition knowledge is another reason. When a nursing infant is weaned off from breast milk in favor of a younger sibling, the weaned toddler’s nutrition deteriorates.

Aside from the usual edema of the lower extremities the following are also found in patients with Kwashiorkor:

• Muscular atrophy
• Excessive belly fat (“pot belly”)
• Regular infections or more severe or protracted infections
• Skin inflammations that start red, then deepen, peel, or break open
• Hair that is dry, brittle, and prone to breakage and even color loss.
• Failure to grow
• Easily agitated 
• Uneven nail growth or splits

For the reasons above, children with Kwashiorkor who go untreated for an extended period of time are at serious risk of contracting further infections, which can be fatal. 

Diagnosis of Kwashiorkor is usually made based on the physical appearance of the child and related questions regarding their food and care. The height and weight of the child is routinely measured and their body fat percentage is determined by a special scale. A skin or hair biopsy and the following blood and urine tests can also help confirm the diagnosis:

• Protein and sugar levels in the blood
• Liver and kidney health by screening for anemia in blood and urine.
• Mineral and vitamin stores

Treatment

The following 10 actions have been recommended by the World Health Organization for addressing severe undernutrition including Kwashiorkor:

1. Treating or avoiding hypoglycemia
2. Treating or avoiding hypothermia
3. Treating or avoiding dehydration
4. Rectify an electrolyte imbalance
5. Treat and/or stop infection
6. Address deficits in micronutrients
7. Start feeding slowly
8. Achieve catch-up growth
9. Provide sensory stimulation and emotional support
10. After recovery, prepare follow-up

Educating the mothers, especially those who are weaning off their babies prematurely. Going to health centers to access materials or asking any health center staff on how to feed children according to their age is among the easy steps a mother could take.

Lastly, it is important to improve sanitation and give children vaccines to protect them from diseases that could make them less likely to eat enough protein.

References

Benjamin O, Lappin SL. Kwashiorkor. [Updated 2022 Jul 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507876/ 

National Health Services (2022). Kwashiorkor. Retrieved December 10, 2022, from https://www.nhs.uk/conditions/kwashiorkor/#:~:text=Kwashiorkor%20is%20a%20severe%20form,under%20the%20skin%20(oedema).

Cleveland Clinic (2022). Kwashiorkor. Retrieved December 10, 2022, from https://my.clevelandclinic.org/health/diseases/23099-kwashiorkor