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Risk of mortality among children with kwashiorkor versus wasted children

This question was posted the Assessment and Surveillance forum area and has 2 replies.

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Cécile Cazes

Normal user

23 Dec 2020, 17:02


Are you aware of any article documenting the risk of mortality in severely malnourished children from the form of kwashiorikor compared to severely malnourished children who were wasted?

thanks in advance

Mhiret Teshome

Nutrition Expert

Normal user

23 Dec 2020, 20:22

Not as such enough resources. howver it is obivious that the riks of mortality of Kwashiorikor and marasmic children largely associated with the presence of comorbid diseases.

You can have betetr insight from the following two articles.







Retrospective quantitative review of hospital based records using patient files, ward death and discharge registers.

“Children with marasmus had increased risk of dying”

Munthali E, Jacobs C, Sitali L, Dambe R, Michelo C. Mortality and morbidity patterns in under-five children with severe acute malnutrition (SAM) in Zambia: a five-year retrospective review of hospital-based records (2009–2013). Arch Public Health. 2015;73:23

Confounding factors (infection with HIV, pneumonia etc. ruled out.


Four years retrospective cohort study on 500 under-five children admitted with the diagnosis of severe acute malnutrition

Children with marasmus and those with repeated admission had reduced survival rates

Yohannes, T., Laelago, T., Ayele, M. et al. Mortality and morbidity trends and predictors of mortality in under-five children with severe acute malnutrition in Hadiya zone, South Ethiopia: a four-year retrospective review of hospital-based records (2012–2015). BMC Nutr 3, 18 (2017).

Pneumonia found be to be the most common comorbid disease.

Merry Fitzpatrick

Assistant Research Professor

Normal user

1 Jan 2021, 20:28

There have been a number of studies that have made this comparison.

The results of these studies have been mixed.  Most point to increased mortality in severe acute malnutrition if edema is present, though a few have either not found a difference or found that malnutrition without edema had higher mortality.  In nearly all cases, a mix of wasting and edema (i.e. marasmic kwashiorkor) has the highest mortality.

The differences seen could be due to the way the population views each type of malnutrition (for example, bringing one type or another for treatment only after they are very severely malnourished), the appropriateness of the treatment given, and a whole host of other factors that probably vary from one place to another.  Or it could be due to the type of malnutrition itself.  For example, we do know that children with kwashiorkor have many more metabolic anomalies than marasmus without edema, and that these anomalies linger long after the edema clears, and this may complicate treatment.

Hope this is helpful.

Schofield, C. and A. Ashworth, Why have mortality rates for severe malnutrition remained so high? Bulletin of the World Health Organization, 1996. 74(2): p. 223-229.

Briend A, Wojtyniak B, Rowland MG. Arm circumference and other factors in children at high risk of death in rural Bangladesh. Lancet 1987;2:725–8.

Dramaix M, Hennart P, Brasseur D, Bahwere P, Mudjene O, Tonglet R, et al. Serum albumin concentration, arm circumference, and oedema and subsequent risk of dying in children in central Africa. BMJ 1993;307:710–3.

Prudhon, C., A. Briend, D. Laurier, M. Golden, and J.Y. Mary, Comparison of Weight- and Height-based Indices for Assessing the Risk of Death in Severely Malnourished Children. American Journal of Epidemiology, 1996. 144(2): p. 116-123.

Prudhon C, Golden MH, Briend A, Mary JY. A model to standardise mortality of severely malnourished children using nutritional status on admission to therapeutic feeding centres. Eur J Clin Nutr 1997;51:771–7.

Talbert A, Thuo N, Karisa J, Chesaro C, Ohuma E, Ignas J, et al. Diarrhoea complicating severe acute malnutrition in Kenyan children: a prospective descriptive study of risk factors and outcome. PloS One 2012;7:e38321. doi:10.1371/journal.pone.0038321.

Trehan I, Goldbach HS, LaGrone LN, Meuli GJ, Wang RJ, Maleta KM, et al. Antibiotics as part of the management of severe acute malnutrition. N Engl J Med 2013;368:425–35. doi:10.1056/NEJMoa1202851.

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