Introduction

Well-balanced nutrition is very important for every child’s physical and mental development. 

When a child’s nutritional requirements are not met, malnutrition sets in and the child can develop health problems, some of which can be long-term. 

Kwashiorkor is a health problem associated with feeding and nutrient intake. The main cause is inadequate protein intake: the child takes more carbohydrates and far less protein than the body requires.¹

Protein is known as the building blocks of the body. It is especially useful in the production of enzymes and hormones, fighting infection, maintaining fluid balance, and body-building and repair.²  Poor protein intake in kwashiorkor causes physical, mental, emotional and social health problems in children, which can affect their adolescence and adulthood. 

Kwashiorkor is rare in developed countries such as the UK. It is more common in countries considered as underdeveloped or developing such as some Asian and African countries, where there is severe poverty and lack of food. 

This article aims to highlight the long-term developmental effects of kwashiorkor on survivors. 

Physical developmental effect of kwashiorkor

Kwashiorkor can affect a child’s physical development in the following ways:

• Stunted growth: This is when a child's height is much shorter than the expected height for their age. Stunting can cause permanent brain and physical health issues 
• Muscle wasting: This is when a child's weight is much lower than expected to their height or age (underweight), and the child is emaciated and frail. Muscle wasting can be caused by an inability to gain weight, or the child is losing weight too fast. Although this is treatable, it can place the child at a higher risk of losing their lives
• Delayed puberty: The body needs vitamins, minerals and other nutrients found in a balanced diet to produce hormones and enzymes necessary for the child to mature. Lack of it causes delay in developmental stages such as the period of puberty
• Increased risk of infection: This happens due to the body's reduced immunity. Immunity is reduced when there is poor nutrition

Cognitive and neurological effects of kwashiorkor

When a child has limited access to nutritious food, it causes adverse health issues. Young, growing children especially require an adequate diet to survive and grow. Lack of this harms their brain and physical functions.

Kwashiorkor can have negative neurological effects, such as:

• Shrinkage of the brain: Magnetic resonance imaging (MRI) studies have shown significant changes in children with kwashiorkor. It is possible to reverse this problem with proper nutrition 
• Loss or reduced brain function: The normal brain function in children is disturbed due to poor nutrition present in kwashiorkor

• Poor school performance: When brain function is disturbed, activities such as school work may become challenging for the child. This in turn can affect the child's performance in class³
• Low intelligence quotient: Brain development is impaired when a child is malnourished, especially during early years. This is manifested as low IQ later in life⁴
• Poor attention span

Emotional and behavioral consequences of kwashiorkor

The consequences of Kwashiorkor are numerous, and may affect emotions and behaviour:

• Hostile behaviour toward friends
• Feeling depressed
• Neglecting hygiene and grooming
• Increased anxiety
• Lack of motivation or interest^3,5

Long-term health risks of kwashiorkor

If left untreated, kwashiorkor can have worsening effects:

• Increased risk of surgical complications that can result in loss of life, as a lack of protein impairs wound healing 
• Liver problems
• Heart problems
• Health problems affecting the kidneys and urinary tract
• Increase risk of developing diabetes
• Frequent hospital visits due to recurrent health problems
• Loss of function of the digestive tract leading to persistent digestive health problems^1,5

Socio-Economic impact of kwashiorkor

The socio-economic impact of Kwashiorkor includes:

• Poor work placement as a result of poor education and health 
• Repeated offenders of the law
• increased healthcare costs due to frequent hospital visits
• Reduced income power
• Poor standard of life

Prevention and support strategies

Several strategies can be implemented to prevent people from getting Kwashiorkor whilst supporting those who experience it:

• Improving financial and social situation: Lack of income, or earning a low income may be the cause of feeding on a low protein diet. Improving the financial and social status of parents and guardians can make it easier to get the proper food and nutrients to prevent Kwashiorkor
• Nutritional intervention can be achieved by:
  • Providing balanced nutrition and improving healthy eating. A high-protein diet, especially protein of animal source is essential in tackling kwashiorkor. This provides adequate vitamins and amino acids necessary for building up the child's body 
  • Include foods rich in iron and zinc to the child's diet
  • Mothers should be encouraged to give only breast milk to their babies from birth until the babies are six months old. Proper complementary food can be given while the child is still being breastfed from six months to two years and more
• Promoting informed health choices:
  • Parents and guardians need to be educated about the right source of food and how best to prepare it for their children and wards
  • Awareness about kwashiorkor should be carried out at all levels
  • Hygiene and sanitation should be encouraged to prevent infection that can worsen the effects of kwashiorkor
• Support groups should be made available for survivors of kwashiorkor, where they can learn how to manage long-term health challenges
• Agricultural programs should be encouraged to boost food supply and reduce scarcity. Home gardens and small-scale farming should also be supported 
• Accessible healthcare for nutritional rehabilitation
  • UNICEF recommends treatment with ready-to-use therapeutic food (RUTF). This should be made available and accessible to all who experience kwashiorkor
  • Healthcare workers should be trained to recognise signs of kwashiorkor and initiate treatment immediately
  • Nutritional assessment and counseling should be made a normal part of health services provided

Table showing examples of high-protein foods and their source

FAQs

What is the difference between kwashiorkor and marasmus?

Kwashiorkor is caused by eating more carbohydrates and far less protein than is needed by the body. The main characteristic is the presence of general visible swelling (oedema) and skin changes. 

Marasmus is caused by inadequate intake of both carbohydrates and protein. Weight loss is the main feature of marasmus.⁶

Can a child develop both kwashiorkor and marasmus? 

Yes, it is possible, and when this happens, the condition is known as Marasmic-kwashiorkor. The child presents with both features of kwashiorkor and marasmus. 

Can kwashiorkor affect older persons? 

Yes. It is rare but Kwashiorkor can affect older persons too. Most cases are, however, found in children. 

Summary

Kwashiorkor is a health problem related to poor nutrition. It is especially common in poor countries where food availability is low. The long-term developmental effects of kwashiorkor are numerous, ranging from physical, cognitive to social impacts. The solution lies in the need to improve the standard of living of poor families, make food available and educate parents and guardians on how best to feed their children.