Kwashiorkor a protein-deficiency disorder of children. It occurs after the child is weaned. The clinical symptoms include a vague type of lethargy, apathy or irritability at initial stage of the deficiency, and later retarded growth, mental deficiency, diarrhoea, increased susceptibility to infections, edema, dermatitis, and liver enlargement become apparent. The hair may appear reddish in colour. If the disease has been severe and longstanding, the child may never attain full growth and mental development.

Kwashiorkor is prevalent in over populated parts of the word including Bangladesh, where the diet consists mainly of starchy vegetables and cereals. The other areas where the disorder is quite prevalent include sections of Africa, Central and South America, and South Asia. The weaned child who receives neither milk nor meat, is likely to develop kwashiorkor even if sufficient carbohydrate food is taken; because certain amino acids, the constituents of protein is vital for normal growth.

Although some progress has been made in the past decade, malnutrition levels in Bangladesh remain among the highest in the world. Nearly 700 children die of malnutrition-related diseases including kwashiorkor in Bangladesh every day. Among those surviving, nearly 60 percent under five years old are under weight, and more than half are stunted.

Since 1986, however, through certain community-based programmes and creating awareness among the rural poor people by the Ministry of Health and Family Welfare with support from other related ministries and NGOs, Bangladesh has reduced the proportion of under weight children in the country by about 20 percent, and stunting in children under five by about 25 percent. During this period, infant mortality decreased from 94 to an estimated 77 deaths per 1,000 live births (the rate in 1974 was 140).

Despite such notable progress, the loss of life and productivity due to malnutrition remains one of the country's most critical development challenges. In 1995, the government launched the Bangladesh Integrated Nutrition Project (BINP), with support from UNICEF and the World Bank. The project, one of the major large-scale nutrition programmes operating in developing countries worldwide, has reached more than three million households in Bangladesh. It is best known for its community-based approach and provides nutrition services, child growth monitoring, nutrition counselling and food supplementation for those nutritionally at risk, directed primarily at children under the age of two and pregnant lactating women.

Treatment of kwashiorkor includes dietary therapy with sufficient protein food. The diet however, must be carefully supervised to prevent overloading of the system with excess calories or protein. Other problems associated with the disorder such as edema, and diarrhoea also need to be addressed. [SM Humayun Kabir]

See also malnutrition; health and health sciences