Menu ENN Search

Intervention Study on Cases Presenting Precursor Signs of Kwashiorkor

By Dominique Brunet and Frances Mason

Dominique Brunet is currently working as a nutritionist with SC UK. She has 10 years of experience with SC UK, ACF and Oxfam.

This article is based on a report written by Dominique Brunet which was, in turn, based on the findings of research undertaken by Save the Children UK in DRC.

A further study was undertaken by SC UK1 based on two hypotheses:
Hypothesis 1: It is possible to develop reliable admission criteria for children at risk of developing oedematous malnutrition.
Hypothesis 2: The admission of these children at risk into a supplementary feeding programme (SFP) will prevent the development of oedematous malnutrition.

One hundred children from the health zone of Goma (North Kivu province) aged 15 - 96 months, showing precursor signs of kwashiorkor (bloated face, discoloured and/or uncurled hair and oedema without signs of indentation), were admitted into one of two SFPs for four weeks. These SFPs were sited close to a TFC, hence allowing all cases who developed kwashiorkor during the study to be immediately referred to the adjacent TFC.

In the first SFP (Kanyaruchinya), the first 50 cases showing the precursor signs of kwashiorkor were admitted into the programme and received a supplementary ration2 for 4 weeks, followed by a home visit twice a week.

In the second SFP (Mujda), the first 50 children showing the same precursor signs of kwashiorkor were not admitted into the programme, but simply placed under observation and monitored closely, twice a week, through home visits over the four week period.

A standard questionnaire was used to collect information on the age, sex, weight, height and type of precursor signs on admission and again at each home visit. This data were analysed using EpiInfo v.6.04. Only 8% of the children enrolled at the start of the study were eligible for admission into the SFP based on wasting (weight/height (W/H)). There was a statistically significant difference in W/H z-scores between the two groups at the start of the study (p<0.001), between the two groups at the end of the study (p<0.05) and in the intervention group before and after the four weeks of intervention (p<0.05). There was no significant difference between the two groups in W/H in zscores in the control group between the start and end of the study.

The cases receiving a supplementary ration who did not go on to develop kwashiorkor lost the bloatedness in the face, but the hair signs remained throughout the course of the study. In the control subjects, all the pre-kwashiorkor signs present at the start continued throughout the study.

In the intervention group receiving the supplementary ration, 6% of the cases developed kwashiorkor, compared to 22% of the cases in the control group who did not receive a ration. Therefore the probability of developing kwashiorkor amongst children with pre-kwashiorkor signs was less amongst the children receiving a supplementary ration than those without - relative risk of 0.27 (95% CI 0.08, 0.92).

Amongst those that developed kwashiorkor in the intervention group, the nutritional oedema appeared between days 7-18 of admission, averaging at 11 days. In the control group the average was 20 days (appearing between 6-30 days).


Of the 100 children participating in the study, only 14% developed kwashiorkor during the course of the four weeks. However, the intervention highlights a confounding factor in that the supplement provides a protection role in the development of kwashiorkor. The majority (92%) of cases did not have the criteria to enter the SFP (based on wasting) and hence would not normally be eligible for a supplementary ration. It is important to note that the study only continued for four weeks, and hence any further evolution of the cases is not known after this period.

While the results only partially support hypothesis one, the second hypothesis is fully supported. The study showed that that cases showing precursor signs of kwashiorkor and who receive a food ration have less probability of developing kwashiorkor than similar cases who do not receive a ration.

The conclusions of the study resulted in SC UK proposing to its partner organisations to admit all cases with precursor signs of kwashiorkor into the supplementary feeding programmes. It is also recommended that this study is repeated in another area /country in which kwashiorkor is prevalent in order to validate the findings.

For further information, contact Frances Mason, Nutrition Advisor, Save the Children UK,

Show footnotes

1Save the Children UK avec la collaboration due ProNaNut (Programme National de Nutrition) (2004), Etude d'intervention sur des sujets presentant des signes precurseurs du kwashiorkor. Brunet D.

2The ration received was 2.6 kg of maize flour, 500g haricots beans, 210g of oil and 175g of sugar for week 1; 700g of CSB, 500g haricot beans, 210g of oil and 175g of sugar for weeks 2, 3 and 4. The daily ration equivalent came to 1900 kcal of which 9% was protein and 31% lipid in week 1 and 975 kcal with 13% protein and 35% lipid in weeks 2, 3 and 4.

More like this

FEX: Community-based Therapeutic Care (CTC)

Malnourished Child being fed with ready-touse therapeutic food (RUTF) Summary of published research1 Bedawacho Woreda is a district in Ethiopia, 350 km south of Addis Ababa,...

en-net: Blanket Supplementary Feeding Program(BSFP) Does it need anthropometric measurements?

Dear Team, we are in an emergency sitruation where GAM rate is 30%, Food Insecurity status(IPC 4), and crisis. As a response to that, one of our emergency response is General...

FEX: Outbreak of micronutrient deficiency disease: did we respond appropriately?

By Dianne Stevens, Patricia Araru and Buwa Dragudi, Save the Children (UK) Dianne Stevens is a nutritionist with a Masters in Public Health and Tropical Medicine. She has been...

FEX: Implications of a Coverage Survey in Ethiopia

By Simon Kiarie Karanja Simon Karanja is currently the regional nutrition advisor with GOAL in East Africa. Previously he worked as the CTC Coordinator for GOAL Ethiopia and...

FEX: Improving blanket supplementary feeding programme (BSFP) efficiency in Sudan

By Pushpa Acharya and Eric Kenefick Pushpa Acharya is currently working as Head of Nutrition for the World Food Programme in Sudan. She has a PhD in Human Nutrition from the...

FEX: Short children with a low MUAC respond to food supplementation: an observational study from Burkina Faso

By Fabiansen, C., Phelan, Kevin, P.Q., Cichon, B., Ritz, C., Briend, A., Michaelsen, K.F., Friis, H. and Shepherd, S Summary of research: Short children with a low midupper...

FEX: Case Studies (Special Supplement 2)

3.1 CTC in Ethiopia- Working from CTC Principles Isolated village in the highlands of South Wollo, Ethiopia. By Kate Golden (Concern Ethiopia) and Tanya Khara (Valid...

FEX: Scurvy outbreak and erosion of livelihoods masked by low wasting levels in drought affected Northern Afghanistan

By Fitsum Assefa Signs of scurvy: blackness of the legs indicative of haemorrhage Fitsum Assefa is a nutritionist who recently joined Save the Children, United States (SC/US)...

FEX: CTC in North Darfur, North Sudan: challenges of implementation (Special Supplement 2)

By Kate Sadler (Valid International) and Anna Taylor (SC-UK) People waiting at a clinic in Darfur, North Sudan. Child eating plumpynut® in Darfur, North Sudan. North Darfur...

FEX: Scaling up the treatment of acute childhood malnutrition in Niger

Milton Tectonidis By Isabelle Defourny, Emmanuel Drouhin, Mego Terzian, Mercedes Tatay, Johanne Sekkenes and Milton Tectonidis Emmanuel Drouhin is the Niger Desk Officer,...

FEX: Relapse after treatment for moderate acute malnutrition: Risk factors and interventions to prevent it

Summary of presentation1 based on published research2 View this article as a pdf By Heather Stobaugh and Mark Manary Dr Heather Stobaugh has a PhD in Food Policy and Applied...

en-net: discharge criteria

I have two scenarios, which is some discharge criteria of SAM cases, and it is as follows: 1. Oedema cases: if a child has oedema (++) plus W/H <-3 Z-score, How many weeks...

FEX: Generalised Oedema in COVID-19 Positive Children - A Case Series

View this article as a pdf Experiences on COVID-19 and nutrition captured to date in Field Exchange have been at a programme level rather than at individual case management...

en-net: Is MAM treatment still relevant ?

Given the available knowledge on the impact of MAM treatment vs nutrition prevention activities on the reduction of child undernutrition and mortality, and the huge investment...

FEX: Community based approaches to managing severe malnutrition: case study from Ethiopia

Summary of report1 A mother attends the CTC programme A recent published paper describes Save the Children US's (SC US) experience of setting up a community therapeutic care...

FEX: Kwashiorkor – reflections on the ‘revisiting the evidence’ series

View this article as a pdf Lisez cet article en français ici By Merry Fitzpatrick, Gerard Bryan Gonzales, Alexandra Rutishauser-Perera and André Briend Merry...

en-net: Do we have "SAM Cure Rate" in health facilities running CMAM program

In a health facility where there is both SAM and MAM services (CMAM). Admitted SAM cases who reached to MAM criteria by anthropometric measurements, What are we going to...

FEX: Learning from nutrition interventions in Eritrea, Ethiopia and Kenya

Summary of evaluations1 SC UK survey team in Eriteria SC UK recently evaluated a number of emergency nutrition responses undertaken in Eritrea (Gash Barka and Northern Red...

FEX: Advocacy from Eritrea: working with WFP

By Hassan Taifour Hassan Taifour is the Emergency Response Nutritionist for SC(UK). He graduated from the Faculty of Agriculture, University of Khartoum in 1985 and completed...

FEX: Outpatient therapeutic programme (OTP): an evaluation of a new SC UK venture in North Darfur, Sudan (2001)

Summary of internal evaluation1 by Anna Taylor (headquarters nutrition advisor for SC UK) North Darfur experienced a severe drought in 1999 and 2000. This caused widespread...


Reference this page

Dominique Brunet and Frances Mason (). Intervention Study on Cases Presenting Precursor Signs of Kwashiorkor. Field Exchange 26, November 2005. p6.



Download to a citation manager

The below files can be imported into your preferred reference management tool, most tools will allow you to manually import the RIS file. Endnote may required a specific filter file to be used.