Intensive nursing care of kwashiorkor in Malawi

M. J. Manary, D. R. Brewster

Research output: Contribution to journalArticlepeer-review

33 Scopus citations


The case fatality rate for children with kwashiorkor in central hospitals in Malawi was 30.5% (275/901) in 1995. The purpose of this study was to determine whether improved case management with intensive nursing care could lower this case fatality rate. A total of 75 children admitted with kwashiorkor in Blantyre, Malawi, received intensive nursing care. This included nursing in individual clean beds with blankets, a nurse:child ratio of 1:3, supervised feedings every 2 h, a paediatrician with expertise in treating kwashiorkor always available for consultation, laboratory evaluation for systemic infection and empiric use of ceftriaxone. Nineteen of these children died (25%). The causes of death were life threatening electrolyte abnormalities (hypokalaemia, hyponatraemia, hypophosphataemia) in nine cases, overwhelming infection in eight cases and congestive heart failure in two children. Children infected with the human immunodeficiency virus were more likely to die (9/20), as were children with life threatening electrolyte abnormalities (9/15) and children with more severe wasting. When compared with 225 children treated in the same year at the same institution, who were carefully marched for severity of kwashiorkor, intensive nursing did not improve overall survival.

Original languageEnglish
Pages (from-to)203-207
Number of pages5
JournalActa Paediatrica, International Journal of Paediatrics
Issue number2
StatePublished - Jan 1 2000


  • Case fatality
  • Kwashiorkor
  • Malnutrition
  • Treatment


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