MORTALITY IN SEVERE PROTEIN-ENERGY MALNUTRITION AT NCHELENGE, ZAMBIA

At St Paul's Hospital, Nchelenge district, north-eastern Zambia, routi ne clinical management of 299 children up to 5 years of age with sever e and/or complicated protein-energy malnutrition (PEM) was monitored a nd predictors of outcome analysed, PEM was typed according to a modifi ed Wellcome classification. Overall mortality was 25.8 per cent with 1 3.4 per cent for kwashiorkor, 17.8 per cent for marasmus, 28.0 per cen t for marasmic kwashiorkor, and 48.3 per cent for untyped cases of PEM , Mortality up to 18 months of age was related to the presence of dehy dration, pneumonia or another infectious disorder, severe stunting, an d a mid-upper arm circumference less than or equal to 104 mm, suggesti ng that these children may have been born pre- and/or dysmaturely, At rages 19-60 months, the main predictor of mortality was pneumonia, wit h other infectious disorders and dehydration showing less impact. Rout ine administration of broad-spectrum antibiotics, irrespective of clin ical signs of infection, is most probably the single most effective me asure to reduce the high case-fatality rate due to PEM in developing c ountries.