The case fatality rate for children with
kwashiorkor in central hospitals in Malawi was 30.5% (275/901) in 1995. The purpose of this study was to determine whether improved case management with intensive
nursing care could lower this case fatality rate. A total of 75 children admitted with
kwashiorkor in Blantyre, Malawi, received intensive
nursing care. This included nursing in individual clean beds with blankets, a nurse:child ratio of 1:3, supervised feedings every 2 h, a paediatrician with expertise in treating
kwashiorkor always available for consultation, laboratory evaluation for systemic
infection and empiric use of
ceftriaxone. Nineteen of these children died (25%). The causes of death were life threatening
electrolyte abnormalities (hypokalaemia, hyponatraemia, hypophosphataemia) in nine cases, overwhelming
infection in eight cases and
congestive heart failure in two children. Children infected with the human immunodeficiency virus were more likely to die (9/20), as were children with life threatening
electrolyte abnormalities (9/15) and children with more severe wasting. When compared with 225 children treated in the same year at the same institution, who were carefully matched for severity of
kwashiorkor, intensive nursing did not improve overall survival.