Severe protein energy malnutrition in Lesotho, conditioning factors and death and survival in hospital.

Information was obtained on infants and children admitted for severe protein energy malnutrition (PEM) to Lesotho's central hospital in 1981 and 1982 as regards feeding pattern, socio-economic, environmental factors and vaccination status. Acute gastroenteritis (GE) appeared to be a major precipitating cause in the development of severe PEM. Of children 13-24 months of age only 13% was still breast fed. Compared to kwashiorkor significantly more children with marasmus or marasmic kwashiorkor had never been breast fed, or were early weaned and bottle fed. Above age nine months, children had a similar diet during the last three days before admission. Children of nevermarried single mothers appear to be more at risk for severe PEM. Absence of the father's support and a grandmother as caretaker may be other risk factors as well. The vaccination status was poor. In marasmus death was significantly (p less than 0.01) associated with bottle feeding and survival (p less than 0.05) with breast feeding. In kwashiorkor death was significantly (p less than 0.01) associated with an unprotected source of drinking water and survival (p less than 0.05) with consumption of green vegetables in the last three days before admission and employment of the mother. Data collection in hospital may provide a rationale for interventions in the development of severe PEM and identify those at risk to die from it.