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Traditional perceptions of marasmus in Pakistan.Soc
Sci Med. 1991;32 (2):175-91.
One hundred and
fifty mothers of under-5 children clinically identified as
malnourished were interviewed in their homes in katchi abadis
(squatter settlements) of Karachi. A variety of ethnic and religious
groups were represented. Mothers were shown a photograph of a child
with third-degree malnutrition (marasmus) and were asked what might be
wrong with the child. Virtually of the mothers said that they had seen
the condition, typically identifying it as sukhay ki bimari (Urdu:
'the disease of dryness and thinness'). The majority said that
diarrhea predisposed to sukhay ki bimari, and vice versa, but only 3
of the 150 mothers said that diarrhea and/or lack of food could, in
themselves, cause the condition. Instead, most said that the usual
cause was contact with a woman who had a marasmic child or was
otherwise in a state of ritual impurity. The mediating factor was said
to be a saya ('shadow, influence') emanating from such a person and
ultimately linked with the spirit world. Although the condition was
judged to have a very poor prognosis, mothers described various magico-religious
therapies that could be tried. Treatment by physicians or by giving
more food was considered ineffective or even detrimental, and hiding
of such children was reportedly common because of social stigma.
Subsequent inquiries carried out by the author in Chitral in
northwestern Pakistan produced similar findings except that there, the
condition was known as moordasip and was more overtly associated with
fright and spirit possession. In Karachi, 45 of the 150 mothers
interviewed had children with third-degree malnutrition according to
weight-for-age criteria, 15 of whom died in the course of the study.
In these 45 families especially, early bottlefeeding had occurred,
sometimes reportedly because of fear that the mother was a carrier of
a saya and could pass it on through her milk. Most mothers had only
sketchy knowledge of suitable weaning foods and an appropriate
timetable for introducing such foods, and many showed little awareness
of what their children were eating once they reached the toddler
stage. Implications for the identification and treatment of marasmic
children are discussed. A brief summary of crosscultural beliefs
surrounding marasmus and the 'hard to raise' child is included.
The long-term
effects of early kwashiorkor compared with marasmus. IV. Performance
on the national high school entrance examination.Pediatr
Res. 1990 Sep;28(3):235-9.
This is one of
a series of studies on the long-term effects of early childhood
malnutrition in Barbadian school children. This is the first report of
the relationship between early malnutrition and later performance on a
national examination administered to all 11-y-old children in Barbados
to assign high school seats. We compared scores achieved on the
11-plus examination by 103 boys and girls with histories of marasmus
or kwashiorkor with those obtained by 63 healthy comparison children
and also with scores obtained by the total island population of
children during the same years. We report that children with histories
of either type of malnutrition confined to infancy had significantly
lower scores on the national high school examination than healthy
comparison children. Reduced 11-plus scores were closely associated
with teacher reports of attention deficits in the classroom documented
when the children were as young as 5 to 8 y of age and also with IQ
and academic performance. Early malnutrition had independent effects
on performance on the 11-plus examination even when home environmental
conditions were controlled for. These findings have important
implications for future opportunities available to children with
histories of infantile malnutrition.
Peliosis
hepatis in a patient with marasmus.Gastroenterology.
1988 Sep;95(3):805-9.
Peliosis
hepatitis is a rare disorder previously seen in tuberculosis and
malignant disorders and now seen with anabolic steroid use or after
renal transplantation. We report the first case of peliosis hepatis in
a patient with marasmus and no previously reported predisposing
condition. Of interest, the peliosis hepatis resolved rapidly (over
2-3 wk) as determined by computed tomography scan and the patient
presented with a cholestatic enzyme pattern that resolved with
development of the lesion.
Long-term
effects of early kwashiorkor compared with marasmus. II. Intellectual
performance.
J Pediatr Gastroenterol Nutr. 1987
Nov-Dec;6(6):847-54.
Intellectual performance including IQ (Wechsler Intelligence Scale for
Children-Revised) and conservation was measured at ages 11-18 years in
a follow-up study of Barbadian girls and boys who had histories of
kwashiorkor (n = 53) or marasmus (n = 55) in their first year of life.
They were compared with healthy neighborhood children matched by sex
and age who had normal patterns of growth in early childhood (n = 58).
On both IQ and conservation tests, children with previous kwashiorkor
or marasmus had similar scores, which were significantly lower than
scores of healthy comparison children. These findings were examined in
relationship to current environmental conditions, which were similar
in children with histories of kwashiorkor or marasmus and somewhat
less advantaged than those of the comparison children. The effect of
early malnutrition and related conditions at the time of episode still
emerged as significant even when the current environmental factors
were controlled for.
Cellular immunity in
adult marasmus.Vol. 137 No. 10, October 1, 1977
Twelve
patients with recent weight loss to less than 85% of standard
weight-height ratio and a serum albumin level of at least 3
gm/100 ml were considered to have the adult equivalent to
marasmus. Cellular immune function was assessed by delayed
hypersensitivity skin testing to Monilia and streptokinase-streptodornase,
peripheral lymphocyte count, proportion of T and B cells,
whole blood and isolated lymphocyte transformation to
phytohemagglutinin, pokeweed mitogen, concanavalin A, Monilia, and
streptokinase-streptodornase. Significant impairment of skin
test reactivity while in vitro responsiveness remained
intact was noted in the marasmic patients. No impairment
was found in 12 individuals with recent weight loss who
remained at a weight greater than the 85% weight-height
ratio. In four marasmic individuals in whom weight loss was arrested
by nutritional repletion, skin reactivity returned without
substantial change in weight. In this type of marasmus,
both depleted nutritional status and weight loss must be
present for impairement of skin test responsiveness. These
findings confirm relative sparing of more vital functions dependent
on protein metabolism in adult marasmus compared to the
kwashiorkor-like syndromes of hypoalbuminemic malnutrition
seen in adults.
The quality of
the diet in Malawian children with kwashiorkor and marasmus.
Matern Child Nutr. 2006 Apr;2(2):114-22.
Nutritionists
have suggested that kwashiorkor is related to low dietary protein
and/or antioxidant intake. This study explored the hypothesis that
among Malawian children with severe malnutrition, those with
kwashiorkor consume a diet with less micronutrient- and
antioxidant-rich foods, such as fish, eggs, tomatoes and orange fruits
(mango, pumpkin and papaya), than those with marasmus. A case-control
method with a food frequency questionnaire was used to assess the
habitual diet. Children with severe childhood malnutrition presenting
to the central hospital in Blantyre, Malawi during a 3-month period in
2001 were eligible to participate. The food frequency questionnaire
collected data about foods consumed by siblings <60 months of age in
the home. It was assumed that the habitual diet of all siblings 1-5
years old in the same home was similar. Dietary diversity was assessed
using a validated method, with scores that ranged from 0 to 7.
Regression modelling was used to control for demographic and disease
covariates. A total of 145 children with kwashiorkor and 46 with
marasmus were enrolled. Children with kwashiorkor consumed less egg
and tomato than those with marasmus: 17 (15) vs. 24 (31) servings per
month for egg, mean (SD), P < 0.01 and 27 (17) vs. 32 (19) servings
per month for tomato, P < 0.05. Children with kwashiorkor had a
similar dietary diversity score as those with marasmus, 5.06 (0.99)
vs. 5.02 (1.10), mean (SD). Further research is needed to determine
what role consumption of egg and tomato may play in the development of
kwashiorkor.
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