dc.description.abstract | PEM a highly prevalent condition in almost all developing countries, including Kenya is treated
with high calorie, high protein feeds. At the KNH special milk is used for the rehabilitation of
children with PEM. Special milk is prepared using dry skimmed milk, com oil, eggs, and sugar.
In Indonesia, a traditional food called tempe has been used in the rehabilitation of children with
PEM. Tempe is prepared by fermenting cereals or legumes or a mixture of both with the fungus
Rhizophus oligosporus. In this study comparison of special milk with tempe in the nutritional
rehabilitation of children with either kwashiorkor or marasmic kwashiorkor in the paediatric
wards of KNH was done. The period of observation was ten days which mainly covered the
acute resuscitation phase. The total protein, albumin, and Hb were determined on the first post
admission day, day four, day seven and day ten. Daily observations were done to determine the
duration of oedema, apathy, diarrhoea, and changes in weight.
A total of 90 children with a diagnosis of kwashiorkor or marasmic kwashiorkor were recruited
and randomly allocated to either tempe group or special milk group. Each group had 45 children.
Overall the 52 children had kwashiorkor and 38 had marasmic kwashiorkor. Each of the
treatment groups had equal representation of kwashiorkor and marasmic kwashiorkor. The mean
age in the tempe group was 26.1 ± 12.9 months. The mean age in the special milk group was
22.7 ± 10.6 months.
For each group there was a significant increase in the serum protein levels during the study
period (p = 0.000). The rate of increase in serum proteins in the special milk group was 1.3 g per
day while the rate in the tempe group was 0.9 g per day. On the other hand comparison between
the two groups showed that there was no difference between the mean serum protein values
during the period of the study (p= 0.073-0.831).
There was a significant increase in the albumin levels as the days of feeding progressed. The
change in albumin levels was not affected by the type of feed (p= 0.0134). There was no
difference between the mean levels of serum albumin in children fed on tempe and those fed on
special milk throughout the period of investigation (p= 0.562-0.855).
The mean Hb levels at the beginning of the study were similar and there was no significant
change during the period of study (p= 0.500).
Only 32% of the children gained weight. Twenty percent of these were in the special milk group
and 12% were in the tempe group. Analysis of variance for paired data of tempe and special milk
showed that the increase in weight in the two groups was not significantly different as the days
progressed (p= 0.331). On linear regression analysis the increase in weight in the tempe group
was not significant (p=0.988), while the increase in weight in the special milk group was
significant (p=0.001). The growth rate for the children in the tempe group was 12.27 g per
kilogram body weight per day while it was 16.01g per kilogram body weight per day in the
special milk group. The rest ofthe children in the two groups continued to lose weight until they
were discharged from the study on the 10th day .
. There was no significant difference in the mean duration of diarrhoea, apathy and oedema
between the tempe group and the special milk group (p= 0.323, 0.493, and 0.907 respectively).
Survival analysis of the data was done for diarrhoea, apathy, and oedema. The results showed
that the children in the tempe group had lower probabilities of surviving with clinical features of
diarrhoea, apathy and oedema for all the time intervals.
It was concluded that tempe could be as good as special milk in the nutritional rehabilitation of
children with severe PEM. | en |
dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |