The Tema General Hospital, the only referral hospital within the Tema catchment area in the Greater Accra Region, recorded 11 deaths among children aged below five years as a result of Kwashiorkor, a nutrition-related condition medically known as Severe Acute Malnutrition.
Of the 11 children who died in 2023, one each came from Ashaiman, Ashaiman-Jericho, Dawhenya, and Tema Communities 25 and 22; and three each came from Tema Newtown and Kpone-Katamanso, all in the Greater Accra Region.
Suffering from Kwashiorkor comes with some physical symptoms, including oedema (swellings of the feet, hands, face, or trunks), rib cage visibly out, bloated stomach, pale skin, tiny and tightly curled hair, as well as loss of teeth, and skin or hair depigmentation.
Cicely Williams, a Jamaican, is credited to be the first researcher to use the word “Kwashiorkor” a name in Ga (the Language of the indigenous people of the Ga State of Ghana) to describe the nutritionally deficit disease of children.
Kwashiorkor, known medically as severe Acute Malnutrition (SAM), is mostly referred to as a disease of a baby deposed from the breast when the next one is born, which often occurs when the baby is weaned from the protein-rich breast milk and given foods that lack protein.
The “Interim National Guidelines for Community-Based Management of Severe Acute Malnutrition in Ghana”, a document of the Ghana Health Service (GHS), says SAM is one of the two types of Acute Malnutrition with the other being Moderate Acute Malnutrition.
“SAM, or severe acute malnutrition, is defined by the presence of bilateral pitting oedema or severe wasting. A child with SAM is highly vulnerable and has a high mortality risk,” it said.
The GHS acknowledges that the disease remains a major public health and developmental challenge in Ghana as its prevalence remains high and contributes to the morbidity and mortality of children under five years.
Causes and Effects
Many things have been attributed to children becoming Kwashiorkor; these include poverty, which makes it difficult for parents to have access to food to feed their weaned toddlers.
Others who also have access to food may have a limited variety of the needed nutrients in their diet as nutritionists have identified that feeding children with only carbohydrate porridges, such as the popular ‘mori koko' (corn dough porridge in Akan) does not contain any nutrients to aid the child's growth.
Some children also become susceptible to the disease due to medical conditions, which make it difficult for them to feed well, while others were due to food insecurity and famine in their countries. Another factors may include the lack of education or awareness of what constitutes adequate nutrition for a growing child.
The United Nations Children's Fund (UNICEF), said Severe Acute Malnutrition, also known as severe wasting in children, does not only steal their health but also makes them 11 times more likely to die from diseases and infections that can easily be treated. These diseases include malaria, cholera, and pneumonia.
SAM weakens children's immune systems, leads to developmental delays and sometimes death.
The Ghana Health Service's Interim National Guidelines for Community-Based Management of Severe Acute Malnutrition in Ghana calls for inpatient care for children suffering from kwashiorkor with other medical conditions such as unconsciousness, high fever, severe dehydration, lower respiratory tract infection, and severe anaemia.
These conditions must be treated alongside the SAM, which is treated with therapeutic milk and Ready-to-Use Therapeutic Food (RUTF).
The milk contains the right balance of nutrients from skimmed milk, oil, minerals, and cereal flour, while the RUTF is groundnut paste composed of vegetable fat, peanut butter, skimmed milk powder, lactoserum, maltodextrin, sugar, and a combined mineral and vitamin mix.
The RUTF is recognised as an integral part of outpatient treatment for SAM as it allows children to be treated at home rather than in hospitals.
It is an energy-dense mineral- and vitamin-enriched food with low water activity, preventing bacteria growth in it, making it ideal to be taken home for outpatient care.
Challenges with RUTF Availability
Treating Kwashiokor with the RUTF is not covered under the National Health Insurance Scheme, and the popular Plumpy-Nut (a commercial RUTF produced in France) is no longer available for free treatment as the UNICEF support for the country has ended.
This has left nutritionists to rely on the locally produced version of the therapeutic food from Project Peanut Butter, located in Kumasi, at a cost.
Ms Joyce Asare Kissi, the Head of Nutrition, Tema General Hospital, however, said the supply from Project Peanut Butter has also stalled for a long while for reasons not known to the hospitals.
She said in a bid to reduce the mortality rate among children with kwashiorkor, nutritionists follow the WHO's guidelines to produce their own therapeutic food and milk with local ingredients to be given to both in-patients and out-patients for a token.
The challenge, however, is that some parents from poor backgrounds found it difficult to continue feeding the children with the RUTF when discharged from hospital, leading to relapses and, in some cases, deaths, as in the case of the 11 children who died in 2023 at the Tema General Hospital.
Unfortunately, these children and their parents reside in communities where food was not difficult to come by, however, due to poverty or lack of awareness of what constitutes good nutrition, they suffer in silence, and their parents watch their lives fade away.
Tema, which is projected as the centre of the world, does not only have the port that receives all food items, including cereals imported into Ghana, but also a fishing harbour and several companies producing canned fish, baby foods, and cereals, among others.
Ashaiman and Dahwenya have irrigation dams producing cereals such as maize and local rice, which are known to be very nutritious.
Kpone and Tema Newtown do not only have their people engaging in fishing activities but also cultivating various crops including vegetables and fruits.
The big question, therefore, remains: How come many children within these communities are becoming severely malnourished with some dying from Kwashiorkor?
This calls for conscious efforts by all stakeholders to ensure that companies within these areas, as part of their corporate social responsibility, must support poor families with some of their products to ensure healthy diets.
As a multifaceted and complex problem with socio-economic and cultural implications, more education needs to be carried out in these communities on the need to feed children with nutritious foods and seek medical care as early as possible to avoid complications.
Also, the plea of nutritionists to the National Health Insurance Authority to include the treatment of Kwashiokor in the Scheme should be given utmost priority to prevent needless deaths among under-five children, which rob the country of her precious human resource.