The nutritional status and feeding practices among sick urban pre-school children admitted to a major hospital in Accra, Ghana.

In a prospective study of 652 sick pre-school children only 33% were found to be adequately nourished. Among the malnourished, 54.3% had first degree malnutrition while 32.3% and 13.4% had second and third degree malnutrition respectively. The majority of malnourished children (72.4%) had undernutrition: kwashiorkor (14.2%), marasmus 7.3%) and marasmic kwashiorkor (6.1%) was relatively less common. Furthermore, 58% of the underweight children were stunted, indicating malnutrition of some considerable duration. Malnutrition was essentially of postnatal origin and closely related to a high incidence of malnutrition-associated illnesses: diarrhoea (74%), measles (51%) and intestinal parasites (54%). Though breast feeding was universal and of adequate duration, milk production was mostly inadequate because of too early supplementation with low-energy cereal gruels with little or no protein-enrichment. The majority of children came from low socio-economic homes (61%) with mostly illiterate or semi-literate mothers. It is essential that newer methods of teaching be employed in the health education of these unfortunate mothers. Health institutions other than well-baby clinics need to have integrated units for nutritional and immunization surveillance and also for serving as avenues for the supply of free supplementary food items to children with poor weight gain, especially those from poor homes. Clinical Nutrition Units are needed to ensure that inpatients receive nutrients sufficient for continuing and catch-up growth.