Kwashiorkor--is it a dying disease?

OBJECTIVE: To review the occurrence of kwashiorkor before and after the establishment of the Diarrhoea Training Unit at a Nigerian tertiary hospital in 1992. DESIGN: A retrospective hospital-based analytical study was undertaken. Groups of subjects were compared using odds ratios (95% confidence intervals) and regression analysis. SETTING: The paediatric wards of the Wesley Guild Hospital, Ilesa, Nigeria. SUBJECTS: The number of children admitted with kwashiorkor, measles, gastroenteritis and marasmus between 1983 and 1991 (group I) was compared with similar data for the period 1993-2002 (group 2). RESULTS: There was a 30.4% reduction in the total admissions between these periods, while incidences of kwashiorkor, measles, gastroenteritis and marasmus fell by 70%, 55%, 57.4% and 55.8% respectively. Reduction in number of kwashiorkor cases between groups 1 and 2 was significantly related to the reduced incidence of measles (p = 0.000002) and gastroenteritis (p = 0.000003). The total number of admissions was correlated with the number of measles (r = 0.623 and 0.573 for group 1 and 2) and kwashiorkor cases (r = -0.412 and 0.233 for groups 1 and 2). CONCLUSION: The incidence of kwashiorkor has fallen in Ilesa, Nigeria. Given the relatively low HIV prevalence rate in the country during the study period, better management of diarrhoeal diseases, including measles, may have accounted for this drastic fall.