I was a young boy in primary four, a displaced refugee in the late 60s, when I first saw a case of kwashiorkor, during the Biafran/Nigerian civil war, and a retired Permanent Secretary when I saw a second case of kwashiorkor in an Internally Displaced Person’s(IDP) camp in Nigeria. In both instances my reactions were the same – I developed a pathological hatred for kwashiorkor. I cannot even in good retaliatory conscience wish my worst enemy kwashiorkor. Let me explain.
You see, in 1968/69 as I just finished primary three, my home town Igbere was over-run by Nigerian military forces, we were all displaced and became refugees. We fled through Eke forest to Iyinmanu forest and finally settled at Mgbaraogwu forest. I then enrolled into a primary school, under the supervision of Rev N E Nwachukwu. I was in class 4, the school was built through community efforts with palm fronts and bamboo seats. This school was facilitated and established through the instrumentality of World Council of Churches(WCC), from their branches in Canada and Scotland through Presbyterian church.
They also established affiliated relief centers around the forest where they distributed stock fish, corn flour, granulated eggs and other protein-energy-biscuits, for Igbere refugees. We, the young ones that enrolled into their make-shift-batcher-school, were privileged to receive regularly, handsome portions of afore-enumerated relief materials. Our mates who refused to enroll into the school, were not so fortunate, and so most of them developed kwashiorkor.
The white missionaries had to battle in their makeshift hospitals, built with the same palm fronts and bamboo beds, to save the lives of these kwashiorkor children. We then knew that the illnesses the children had, were variously described as kwashiorkor, marasmus or marasmic-kwashiorkor, but we had no idea how they got them.
Now, 50 years later, as a retired Permanent Secretary, in this 21st century, the same kwashiorkor is wrecking havoc in Nigerian IDP camps, and some villages of Nigeria. Is history repeating itself? What a pity. For the uninitiated let us explain what kwashiorkor is and how it is managed.
What is kwashiorkor?
Kwashiorkor is a malnutrition disease, chiefly of children, caused by severe protein and vitamin deficiencies, in the presence of normal or high carbohydrate intake, and characterized by retarded growth, changes in pigmentation, pot belly and anaemia. Found mostly in 6 months to 5 years age range, but can also occur in any teen age, especially during the war.
The word kwashiorkor was used by GA tribe in Accra (Ghana) , described by Cicely Williams in 1933, which means “the sicknesses the baby gets when new babies come”, or “the disease of the deposed child “.
What are the alternate names for kwashiorkor?
a) Enfant rouges b) culebrilla c) boufissure d’ Annam d) syndrome pigmentation oedema e) fatty-liver disease f) dystrofia pluricarential g) nutritional oedema syndrome and h) malignant malnutrition.
What are the signs and symptoms of kwashiorkor?
1) Oedema with distended abdomen. 2) Growth retardation 2) Muscle wasting with retention of subcutaneous fat. 3) Psycho motor changes. 4) Diarrhoea. 5) Hair changes. 6) Diffuse de pigmentation of the skin. 7) Moon face. 8) Anaemia. 9) Flaky paint rash. 10) Hepatomegaly. 11) Indolent sores. 12) Moist-groin rash. 13) Associated vitamin deficiencies. 14) Xerophthalmia with vitamin A deficiency is a frequent cause of blindness. 15) Concomitant acute and chronic infections like tuberculosis, measles, salmonellosis and urinary infection. 16) Loss of teeth. 17) Dermatitis. 18) Irritability and anorexia.
How do we diagnose kwashiorkor?
1) Check for enlarged liver.
2) Blood – FBC, arterial gas, Blood Urea Nitrogen (BUN)
3) Blood for creatinin, potassium levels
4) Urine for protein.
Management of kwashiorkor.
• Small but frequent rations of concentrated protein and carbohydrates packs.
• If patient is too weak, immediate admission for electrolyte balance and concentrated protein/carbohydrates/vitamin packs.
• Symptomatic treatment of associated infections, plus vitamin and mineral supplements.
What is our take this week?
Current research and report in Nigeria shows that kwashiorkor is surreptitiously creeping back to Nigeria, and no region is spared. Our charity must begin at home. Look around you for indigent children who cannot afford one square meal a day and lend a helping hand. God will surely bless you.

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