MALNUTRITION: MISSED OPPORTUNITIES FOR DIAGNOSIS

Abstract

Introduction: Malnutrition is a serious public health problem particularly in developing countries where it is responsible for 54% of under 5s mortality. Anthropometric measurements are key tools for the assessment of nutritional status and diagnosis of malnutrition. Height and weight measurements are not routinely done in most clinics and hospitals in Ghana. Children therefore miss the opportunity for accurate nutritional assessment and detection of malnutrition. Objectives: To determine the prevalence of wasting among children <5 years and to document extent of under-diagnosis. Method: From June to August 2004, children aged >3 months to <5 years attending the outpatient clinic of Komfo Anokye Teaching Hospital were systematically assessed for wasting using weight-for-height standard deviation score (Z-score). Results: Of 1182 children (mean age 24.9 months), 251 (21.2%) were wasted, 48 (4.1%) of them severely. Only 15 (5.9%) of the 251 children with wasting were so identified by the attending physician. Conclusion: Malnutrition is widespread yet underdiagnosed. Anthropometric measurements should be promoted in all child health clinics. Keywords: wasting, malnutrition, weight-for-height, Z-score, missed opportunities INTRODUCTION Nutritional disorders stem from imbalance between supply of protein-energy and the body’s demand for them to ensure optimal growth and function. This imbalance includes both inadequate and excessive nutrient intake; the former leading to malnutrition in the form of wasting, stunting and underweight whilst the latter results in overweight and obesity. Malnutrition, defined in this context as nutritional deficiency, is a serious public health problem that has been linked to a substantial increase in the risk of mortality and morbidity.1 It is estimated that 9% of children below 5 years of age globally suffer from wasting.2 In developing countries, however, prevalence of malnutrition among the under 5s is estimated at 27%.3 Malnutrition is responsible for 54% of all deaths among children <5 years of age.4 It is important, therefore, that children are properly assessed for evidence of malnutrition. The assessment of nutritional status according to weight-for-height, height-for-age and presence of nutritional oedema is summarised in Table 1. Whilst the child with oedematous malnutrition could easily be identified by most clinicians, wasting as a form of malnutrition could easily be missed if anthropometric measurements are not done. Growth assessment in terms of anthropometry is routinely done at child welfare clinics.