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Severe Malnutrition: a Global Approach. INSTITUTION International Children's Centre, Paris (France)

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Severe Malnutrition: a Global Approach. INSTITUTION International Children's Centre, Paris (France) , DOCUMENT RESUME ED 371 865 PS 022 466 AUTHOR Pelletier, Jean-Gerard TITLE Severe Malnutrition: A Global Approach. INSTITUTION International Children's Centre, Paris (France). REPORT NO ISSN-0379-2269 PUB DATE 93 NOTE 88p. AVAILABLE FROMChildren in the Tropics, International Children's Centre, Chateau de Longchamp, Bois de Boulogne, 75016, Paris, France ($10; annual subscription: $40 for 6 issues). PUB TYPE Collected Works Serials (022) JOURNAL CIT Children in the Tropics; n208-209 1993 EDRS PRICE MF01/PC04 Plus Postage. DESCRIPTORS Biological Influences; *Child Health; Children; Cultural Influences; Developing Nations; Disease Incidence; *Diseases; Foreign Countries; Global - Approach; *Hunger; *Intervention; Medical Services; *Nutrition; Nutrition Instruction; Poverty; Program Evaluation; Rehabilitation; Socioeconomic Influences IDENTIFIERS Anthropometry; KwashisKor; Marasmus; Psychological Influences ABSTRACT This report examines the immediate and underlying causes of malnutrition in the developing world. The first section discusses the effects of malnutrition on childhood development and examines the efficacy of nutritional rehabilitation. The second section addresses the medical effects of severe malnutrition, including the onset of ponderostatural (weight) retardation, behavioral disorders, dehydration, anemia, hypothermia, hypoglycemia. and diarrhea. The third section focuses on anthropometric approaches to treating malnourished children, which treat children on an individual basis based upon their particular condition. The fourth section examines the biological effects of severe malnutrition, discussing deficiencies in serum proteins, electrolytes, trace elements, and hormonal levels, along with their immunological consequences. The fifth section explains the nutritional approach to the problem, looking at protein, vitamin, and mineral deficiencies lnd specific rehabilitation procedures and foods. The sixth section focuses on a cultural approach to malnutrition, discussing dietary and social customs that affect nutrition and eating behaviors. The seventh section examines psychological approaches, looking at the mother-child relationship, psychological problems fostered by malnutrition, and specific interventions. The eighth section addresses social and economic approaches to malnutrition, while the ninth section examines techniques used to evaluate rehabilitation and treatment programs. (MDM) *********************************************************************** * Reproductions supplied by EDRS are the best that can be made * * from the original document. * *********************************************************************** IL I I 0 1 U E. DEPARTMENT OF EDUCATTON OM:* Educattonat Reeetuch end itsprmemsm EDUCATIONAL NEW IRCES INFORMATION CENTE.. AMP yllus document has been ussuoducise as Amami from too 1:41101% Of agamiatton angtnahng 11. 0 Minor changes have WNW made to wnofoue reproduCton oughts ewes of yew of asuman* slated m the dock,- rneM dO not noceseenN moment MOcial OERI pomOon or poltey Aft ." " *:"Za : N "PERMISSION TO REPRODUCE TI SEVERE MALNUTRITION : MATERIAL HAS BEEN GRANTED A GLOBAL APPROACH 1993 - N° 208-209 BEST COPY AVAILABLE TO THE EDUCATIONAL RESOURC INFORMATION CENTER (ERIC)" INTERNATIONAL CHILDREN'S CENTRE PARIS 2 16. The International Children's Ce.--' .! was created by the French govern- ment in 1949, on the initiative of Professor Robert Debréin particular, follo- wing negociations between France and he United Nations. Its purpose was to furnish those international and natior 11 agencies dealing specifically with child care with training facilities 3ndducational and informational tools in the field of child health and development, viewing children withintheir family and surroudings. ICC soon turned essentially toward Third World children anddevoted its activities to the training and education of personnel with social, educational and administrative responsibilities as well as medical and paramedical wor- kers.The desire for greater efficiency has led it to work increasingly with trai- ners and to concentrate its efforts on themethodological and educational aspects of mother and child care programmes. ICC is also engaged in an attempt to further study - and - action on some aspects of the life and health of children and their family, so as tocontribute to practical improvement, particularly in the fields of growth, nutrition,planned parenthood, the control of transmissible and nutritional diseases,preschool and school education, the needs of disabled and underprivileged children, etc. The documentation centre of the ICC has been collecting, processing and circulating invaluable information on children and their environment for the past forty years. In the last decade the centre has alsodeveloped the Robert Debré Database (BIRD) ; with its current 110,000 references, it can meet your bibliographic research needs either by correspondence or by visiting the centre's library. Furthermore the ICC also produces the BIRD CD-ROM,upda- ted yearly with the latest database references; it is a user-friendly compactdisc operated on any IBM compatible PC equiped with a standard CD-ROM drive. ICC also publishes books, proceedings of symposia and educationa!docu- ments, as well as comprehensive analyses and bibliographicbulletins. As for its legal status, the International Children's Centre is a foundation under french law of recognized public utility, administered by an executive board with broad international membership. +- IN THE TROPICS REVIEW OF THE INTERNATIONAL CHILDREN'S CENTRE SEVERE MALNUTRITION : A GLOBAL APPROACH 0 JEAN-GERARD PELLETIER 1993-N° 208-209 On Sunday, 10 October 1993, Professor Djilali BELKHENCHIR was assassinated by several young men, in front of his paediatric department at Birtraria, in Algiers. He had often worked with the ICC on subjects such as the be- haviour of adolescents and the evaluation of health programmes, sharing with us his sound competency, broad experience and pro- found philosophy, which he never failed to put Into everyday practi- ce, and which may be summed up in a very few words : "children first". His 1985 doctoral thesis in medicine, on infant diarrhoea, for which he earned the Nathalle Masse award, was prefaced by the following dedication : "I dedicate this thesis to young Omar SAADI, who died in the battle of Algiers at the age of 11, because he believed that justice could be achieved In this country. To all those little fellows out on the streets throughout the world, who die each day, standing side by side with their elders, for the same ideals." We hope that all those who knew and appreciated him are as deeply affected as we are, and will uphold the memory of his example. 5 3 REHABILITATION : Malnutrition has numerous causes 7 GLOBAL CARE ? Nutntional rehabilitation 11 CLINICAL Severe forms of protein energy malnutrition 14 APPROACH Marasmus 14 Kwashiorkor 15 Marasmus-kwashiorkor 17 Difficulties in treatment 17 Dehydration and fluid and electrolyte disorders 17 Anaemia 19 Hypothermia 19 Hypoglycaemia 20 Cardiac insufficiency 20 Infections 20 Prognosis 25 ANTHROPOMETRIC Review of the main anthropometric tools 27 APPROACH Data collection 27 Analysis of findings 28 Anthropometrics and nutritional rehabilitation 31 Detection and management of children 31 Assessment of the severity of malnutrition 32 Assessment of the child's recovery 33 BIOLOGICAL Biological consequences 35 APPROACH Hormonal consequences 37 Immunological consequences 38 Biological assessment and nutritional rehabilitation 40 NUTRITIONAL Needs 42 APPROACH Therapeutic renutrition 46 The different stages 46 Breast-feeding 46 .11 CULTURAL The anthropology of diet 51 APPROACH Social and cultural anthropology 54 Medical anthropology 56 PSYCHOLOGICAL The role of the psychological setting in malnutrition 61 APPROACH Tools for wholesome development 62 Psychological intervention during rehabilitation 65 Changes in behaviour 65 The intervention itself 68 Psychotherapy 71 Evaluation 72 Stimulation and home follow-up 73 SOCIAL AND Tools for analysis 74 ECONOMIC Socioeconomic characteristics 76 APPROACH A therapeutic attitude 77 EVALUATION OF The purpose of evaluation 78 REHABILITATION Effectiveness of programmes 81 PROGRAMMES 7 5 Jean-Gerard In 1989-'4, Jean-Gerard Pelletier worked in Cochabamba, Bolivia, PELLETIER within a team of young i3orrvian practitioners who were trying to put this global approach to severe infantile malnutrition into every- day practice. Their rehabilitation centre, by Dr. R. Sevilla, is located in the paediatric department headed by Dr. Lopez within the German Urquidl Hospital. The author of the present document takes entire responsibility for everything it contains, but wishes to state that his experience within this very dynamic team was most valuable for the formula- tion of this overview. He expresses his thanks to : Dr. R. Sevilla and Dr. E. Sejas, paediatricians, Dr. P. Brun (French non-governmental humanitarian agency, "Aux Ouatre Coins du Monde"), Ms. M.L. Flores and Mr. J.C. Lafuente, students of psychology, Mr. P. Chevalier, nutritionist at the ORSTOM, Ms. L. Zalles, biologist and Ms. E. Suarez, student of sociology, the nurses and nurses' aides. In 1988, a Centre for Complete Nutritional Rehabilitation, the CRIN, was created In Cochabamba, Bolivia, on the initiative of a group of nutritionists from the Institut Francais de Recherche Scientiflque pour le Developpement en Cooperation (ORSTOM) and yormg paedia- tricians from Bolivia's San Simon University, supported
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