Collins, Steve; (2001) The assessment and treatment of severe adult malnutrition. Doctoral thesis (M.D), UCL (University College London).

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Abstract

This thesis examines the assessment and treatment of severe adult starvation during famine. The author collected data from 573, 98 and 1059 severely malnourished adults, admitted to therapeutic feeding centres in Baidoa (Somalia) during 1992–3, Ayod (Sudan) during 1993 and Melanje (Angola) during 1993–4. The data collected are unique, recording recovery from extremes of adult starvation hitherto undocumented in the medical literature. All the centres were very rudimentary in nature, with no beds, running water, electricity or equipment for special investigations. Mortality rates in the Somalia centre were 21%; war disrupted the collection of outcome data in the centres in Sudan and Angola. The thesis assesses the relative merits of Body Mass Index, Middle Upper Arm Circumference and clinical signs, for screening adult admissions into therapeutic feeding centres. The analysis demonstrates that the use of Body Mass Index is inappropriate for this role and the discussion proposes a combination of clinical signs and Middle Upper Arm Circumference as an alternative. The thesis also examines the effect on rehabilitation of two diets differing primarily in their protein content (one diet with 156g protein and 16.5Mj of energy day-1, the other with 81g of protein and 16.5Mj of energy day-1). Twenty five percent of oedematous patients given the lower protein diet during the initial phase of treatemnt recovered, compared with only 48% who received the higher protein diet during the initial phases of treatment. This is a three-fold decrease in mortality amongst this group of patients. The extreme levels of social disintegration, violence and death during the fieldwork prevented the execution of prospective highly controlled research. This is always true of the extreme famines where severe acute adult malnutrition is commonest and such difficulties have discouraged scientists. This is a sad state of affairs, as the extreme human suffering that occurs during famine has not received sufficient scientific attention. There is still a great need for research to assist the assessment and treatment of severe adult malnutrition. Although the conclusions of this thesis are tentative, in the absence of other data examining screening cut-offs based upon evidence gathered during famine, these are the best we have.

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