Kwashiorkor and marasmus: changing hospital incidence of syndromic presentation (1957-88).

This clinico-epidemiological study was undertaken to substantiate the impression that the pattern of clinical presentation of protein-energy malnutrition causing kwashiorkor-marasmus syndrome (KMS) is changing over time. An analysis of data for the period 1964-88, obtained from the specialised Pediatric Clinic of the Calcutta School of Tropical Medicine serving mostly the city slums showed decrease (p less than 0.01) in the incidence of chronic edematous forms of severe KMS, less decrease (p less than 0.05) in the incidence of mild-moderate KMS and increase (p less than 0.01) in the incidence of nutritional marasmus and of chronic very severe forms of KMS characterised by extreme retardation in growth and development. Incidentally, a rising incidence of rickets was observed. In the hospitalised cases (1957-88) these observations were corroborated. Data for 1985-88 of NRS Medical College Hospital, Calcutta, a general hospital serving the city as well as the neighbouring rural areas, showed that among the hospitalised city children edematous KMS was proportionately fewer than marasmus. The situation was reverse in the children from the rural areas. The observations suggested that the syndromic presentation of KMS is changing over the last three decades with some rural-urban differences for which only some recent data could be available.