Stephen,C. A; Thame,Minerva M.; Gray,Robert H.; Barker,D. J.; Wilks,Rainford J.; Forrester,Terrence E.; McKenzie,Colin A,
Author Affiliation, Ana.
Tropical Metabolism Research Institute
Primary malnutrition: Can we always tell?
West Indian Medical Journal
Date of Publication
Patterns of disease in the English-speaking Caribbean have changed considerably over the past two decades. There has been a decrease in the incidence of common infectious diseases, an increase in the prevalence of chronic non-communicable disorders and an increase in the incidence and prevalence of HIV/AIDS. However, published estimates suggested that malnutrition continues to be a serious public health problem. It is possible that changing patterns of presentation of severe forms of childhood malnutrition. We have examined records of 435 children admitted to the clinical research ward of the Tropical Metabolism Research Unit (TMRU) from January 1, 1990, to December 31,1999; among these were 25 children who were subsequently found to have severe childhood malnutrition (SCM) due to a defined medical or surgical disorder (ie secondary SCM). Among children with secondary SCM, the HIV/AIDS group was the largest and comprised of 60% of these admissions. Regression analyses show that, over the ten-year period, there was a small, non-significant decline in the number of cases of primary SCM (incidencerate ratio, IRR = 0.99, 95% confidence interval = 0.96, 1.02, p = 0.98), while the number of cases of secondary SCM increased (IRR =1.18, 95% CI = 1.03,1.35, p = 0.02). These data are indicative of the need for continued viligance in the evaluation of children who have clinical features of the syndromes of severe malnutrition and draw attention to the potential impact of HIV/AIDS in yet another area of healthcare delivery.....