Primary malnutrition - can we always tell?

ABSTRACT

OBJECTIVE: To determine if there was a decrease in admissions for primary malnutrition and an increase in those for initially undiagnosed secondary malnutrition over the period January 1, 1990 to October 31, 1999 at the Tropical Metabolism Research Unit (TMRU). DESIGN AND METHODS: A retrospective review of all admissions, for treatment of malnutrition, to TMRU using admission books and patient records was done. Children were classified with secondary malnutrition if diagnosed after admission with illnesses known to cause malnutrition. Those known to have such conditions on admission or who were over 10 years old were eliminated. Nutritional diagnosis according to the Wellcome classification, age at presentation, sex and birth weight were reviewed. RESULLTS A total of 411 patients were admitted to the TMRU during this 10-year period and 23 of these had secondary malnutrition have increased, especially since 1998. Children with secondary malnutrition were usually marasmic (78 percent), had low normal birth weight (2.8kg) and presented at a later age (15.3 months). The most common secondary cause of malnutrition was HIV infection (56 percent). CONCLUSION: There has been an increase in initially undiagnosed secondary malnutrition seen at TMRU over the last ten years even with a decrease in admissions for primary malnutrition. This may be due to subtlety of presentation and indicates a need for increased vigilance in assessment by health professionals in order to optimize management.(Au)