Protein Energy Malnutrition and the Nervous System: the Impact of Socioeconomic Condition, Weaning Practice, Infection and Food Intake, an Experience in Nigeria

Parental socio-economic condition, childhood infection, weaning practices, and childhood intake of food adequate in protein are known to influence the evolution of protein energy malnutrition (PEM) but this is only scantily documented for our setting. To evaluate the impact of these factors on the development of PEM and its neurological sequel in our setting, sixty-seven malnourished children attending our nutritional rehabilitation centre were analyzed for demographics, weaning age, weaning diets, weights and weight-for-age deficits, parental socio-economic conditions, literacy levels and annual per capita income. They were categorized using modified Welcome classification into four classes of PEM. Predominant neurological manifestations included delayed walking skill, hyperreflexia, spinal ataxia and nutritional neuropathies. Their parents were graded into five socio-economic classes according to the Registrar-General's occupational classification. A survey of food items produced by the parents and the proportion utilized for childhood consumption was carried out. The 67 children, 42 females and 25 males aged 3 months to five years, were categorized as marasmus (18%), marasmic kwashiorkor (16%), kwashiorkor (15%), and underweight (51%). Female children out-numbered males in all age groups and were more often severely affected than males. Children suffering from marasmus (mean age =15.4 months) were significantly younger (p< 0.05) than cases of kwashiorkor (18.1 months) and marasmic kwashiorkor (23.2 months) and those who were underweight (18 months). The commonest predisposing infection was recurrent diarrhoea (24, 35.8%), followed by intestinal parasitic infestation (10, 14.9%) and measles (8, 11.9%). The Registrar-General's occupational grouping placed most (91.6%) of the fathers and all mothers in the low socio-economic classes. Only meager proportions of parents produced protein rich farm products and utilized them child care. Poor parental socio-economic condition, infections, faulty weaning practices and low intake of protein-rich diet are vital to the development of PEM in our setting.