Nutrition: impact on immunity and treatment

by Ebbina Clorah, IPP media, 18 Oct 2006

Good nutrition improves immunity and so helps in the prevention of infections. Malnutrition is a significant underlying factor in more than half the deaths of young children in developing countries.

This is particularly true for deaths from diarrhoea, measles, acute respiratory, infection, meningitis and malaria. Malnutrition impairs the immune system so that infections are more frequent, more serious and last longer.

Programmes for the prevention and early treatment of childhood illnesses include several key nutritional interventions such as reducing prevalence of low birth weight.

For instance, that can be done by using the life cycle approach nutrition and improving infant feeding through complimentary feeding. Preventing micronutrients deficiency is another way.

Infant feeding can be improved by practicing good antenatal care, encouraging exclusive breastfeeding for at least six months and giving complimentary feeding.

Breastfeeding, particularly exclusive breastfeeding reduces the number of infections and deaths in infants. In developing countries non- breastfed infants are three to four times more likely to die in the first three months of life.

The risks are particularly high where environmental contamination and risk of diarrhea and respiratory infection is common.

Breastfeeding also protects older infants for example breastfed infants aged between four to eight months are sixty to ninety per cent less likely to die from infectious diseases. Breast milk contains live cells and immunoglobins which give babies immunity to many infections.

However, it is sad to note that breast milk can transmit HIV. In some cases where hygiene is good, mothers are well informed and the family can afford an approapriate substitute to breastmilk.

The risk of infant death from HIV related infections acquired through breast milk is much greater than the risk of infection in children who are not being breast fed.

However, in many situations the use of breast milk substitutes is extremely harzadous and carries a higher risk than breast feeding.

Recent studies suggest that for the first three months HIV positive mothers who breast feed exclusively are less likely to transmit HIV to their infants compared to those who either mix breast milk with other feeds or never breast feed.

A number of women in poor countries develop subclinical mastitis. This tends to increase the number of inflammatory cells and HIV viruses in breastmilk. Therefore prevention of mastitis may be an important way of reducing transmission of HIV through breast milk.

Children who grow poorly are more likely to suffer from serious infections or die. Detect growth faltering early by regularly weighing the child in the first year. Prevent poor growth and improve immunity giving good food to children over six months to complement and later replace breast milk.

Many micronutrients are also needed for a healthy immune system. In order to maintain good immune system the micronutrients like vitamin A, Zinc, Iron vitamin D should be provided through giving foods rich in these nutrients.

Health workers and parents must work together to improve the nutrition of adults and children to break the cycle of malnutrition and related infections in the community.

In severe cases of malnutrition the first choice treatment is referral to hospital but if that is impossible these children can be managed at rural health centres where staff are available twenty four hours a day but the problem is limited resources in these centres.

The child should be assessed and then admitted in hospital. The health worker assess visible severe wasting, (marasmus), or oedema (kwashiorkor).

The child is assessed on accompanying conditions such as dehydration or any other infections.

Malnourished children are usually anorexic, they have thin gut walls, damaged metabolism and too much sodium in their bodies. Initially, they need diet low in protein and salt.

These feeds should be given in small amounts at frequent intervals until the child tolerates enough milk feeds.

These children often vomit after oral feeds therefore they need close monitoring on feeds and usually intravenous fluids are administered until vomiting stops. The fluids are given according to body weight.

Solids are withheld until vomiting stops. If there is oedema the child is weighed on daily basis to asses improvement by weight loss.

In marasmus weight gain should be noted on improvement of the child. In breastfeeding children suckling must be encouraged after drinking the milk feed.

The child should be kept warm in order to prevent hypotherma.

The child should be clothed and covered with a blanket as severe malnourished children often suffer hypothermia.

These children need antibiotics immediately because infections are common and the usual signs are often absent.

There is no specific sign of infection, oral cotrimoxazole paedtriatic suspension twice daily for five days should be given.

If a child looks sickly, ampicillin intramuscularly or intravenously every six hours should be given six hourly for two days and gentamycin intramuscularly or intravenously once per day for seven days.

If the child does not improve within two days or if gentamycin is not available chroraphenical can be added for five days. In malarial areas treatment for malaria should be given using local guidelines.

A high dose of Vitamin A is necessary in severe malnutrition. Multivitamins should be given to improve appetite but iron should not be given until the child’s appetite returns as iron may make infection worse.

To boost electrolyte balance complimentary supplements like potassium magnesium, zinc and copper should be given as these are essential for recovery.

If the child is suspected to be HIV positive, associated conditions are treated and arrangements for counselling of the parents are made.

Many HIV positive children can recover from malnutrition although it may take longer than usual. The child is also immunised against measles if there is no record that it has been given.

When the child improves, the health worker discusses with the family on how to give a good mixed diet and the care at home.

It is very important to know that the family can afford the child’s diet and give advice accordingly. The child should be reviewed until the health professionals are satisfied with the condition.