A prospective 15-year follow-up study of kwashiorkor patients. Part I. Physical growth and development.

A series of 221 infants admitted to hospital with kwashiorkor between 1958 and 1960 has been followed up for 15 years. Seventy-two (32%) died of malnutrition either at the time of first admission or shortly thereafter. The subsequent physical growth and development of the survivors remaining in Cape Town has been compared with that of 89 of their siblings who had never had kwashiorkor, but grew up in the same environment. No differences were noted between the two groups, but considered together they demonstrated a pattern of retarded growth and delayed development. This suggests an adaptive mechanism suited to survival in poor socio-economic circumstances. The years of poor growth in childhood and early adult life are not associated with an undue mortality, and malnutrition exacts its toll of morbidity and mortality in the early years of life. It is to this age group that intervention with short-term solutions (food subsidization and supplementation) should be applied with the expectation of demonstrable benefit. The long-term solution depends on advancing socio-economic conditions, bringing better nutrition and enlightened health practices; this will eventually lead to improved standards of growth and development.