Doctors Say Disease, Infection Play Major Roles in Deaths of Ethiopians : Children Suffer the Most Even if They Survive

Times Staff Writer

Most of the estimated 900,000 Ethiopians who died of famine in 1984 were children. Death, however, was likely marked by infection or diarrhea caused by the breakdown of the body's immune system, not starvation alone.

According to Dr. George Bray, chief, division of diabetes at USC, the child dying of famine under squalid conditions in an Ethiopian village or refugee camp, suffers the "vicious interactions" of malnutrition, infection and diarrhea. "When the body's immune system is severely compromised, not only is the body using up protein and calorie stores, which are the hallmarks of malnutrition, but compounded by susceptibility toward infection. This puts added demands on the body and the result is often death," Bray said.

Unlike adults whose energy requirements peak at adolescence, children have two to five times the calorie needs per pound or kilo weight as adults. Growing children from 4 to 6 years require 1,830 calories and those 7 to 9 years of age need 2,190 calories per day. From 10 to 16 years calorie needs begin at about 2,800 for boys and about 2,400 for girls. A growing child, therefore, cannot sustain prolonged periods of protein and calorie depletion when the body's calorie requirement for sustenance, much less growth, has been hampered.

According to Bray, there are two types of malnutrition that affect the starving child. Protein deficiency occurs when no protein source is available. During the growing years, a child deprived of protein will show signs of kwashiorkor, a severe disease characterized by stunted growth, edema and a protuberant belly. The skin, hair and bone formation stops, hair turns red and the liver becomes fatty due to salt and water retention. In some countries where the low protein casaba melon is the staple in the diet, weaned children on the casaba diet develop protein-deficiency disease.

The second form of malnutrition is calorie or energy deficiency, created by lack of adequate calories to sustain fat, tissue, brain, and numerous other functions that rely on vitamin-mineral sources derived from calories for health.

Calorie deficiency, superimposed on protein deficiency, causes a breakdown of the body's vital systems: Brain and physical performances are impaired; night blindness and other effects of vitamin-mineral deficiency set in. The body's immune system deteriorates markedly, setting the stage for infection. Once the body depletes its stores of protein and calories, the body cannot fight the effects of infection.

Children, particularly those in the neonatal and first year of life, who do survive the onslaught of starvation and infectious diseases become permanently impaired mentally and physically, according to Bray. "Even if famine stopped, growth of the child has been stunted for life."

Two Phases of Weight Loss Studies in the treatment of obesity through fasting show that there are two phases of weight loss. The first phase occurs during the first two weeks, when the body adapts to energy deprivation by using fat efficiently by burning it slowly. The brain, which normally sustains itself on glucose, adapts by living on fatty acids. "The body simply makes glucose by raiding muscle," said Bray.

After the two-week period, the body adapts by using up the fat stores until none is left. The body then turns to muscle for sustenance. In effect, the body begins to feed on itself. A growing child, whose energy needs are greater than those of adults, will run out of fat and muscle at a faster rate.

The picture of starvation in Africa differs markedly from the face of starvation in concentration camps during World War II, according to Bray. Despite calorie deficiency, fat depletion accounted for high incidences of such diseases as night blindness, scurvy and beri-beri, but the individual may have survived because of the adult body's adaptive mechanism.

Likewise, an adolescent suffering from anorexia nervosa who self-inflicts starvation may lose weight (down to 60 to 70 pounds in the severest form), show the features of starvation with little or no fat on the bone, reduced or ceased menstruation, night blindness, changes of skin pigmentation and behavioral problems. But age and hygienic environment will save the body--and in most cases--life.

Major Consequences "Like adults in concentration camps, adolescents have already reached peak growth and will be adaptive to deficiencies. But similar ravages on small, growing children have major consequences. There is a difference between the anorexic in Beverly Hills and the starved child in Ethiopia. The difference is a clean environment compared to an infected, dry, dirty camp where filthy sewage and water supplies are infested with bacteria," Bray said.

Such conditions are not likely to change overnight in Ethiopia or elsewhere in drought-festered lands of Africa, according to Peter J. Davies, chief executive officer of Inter Action (American Council for Voluntary International Action), a coordinating relief agency for most of major international food aid and refugee agencies.

"What we see in Ethiopia is only the tip of the iceberg. In 1985 we will witness the growth, not shrinkage, of the famine problem in Africa. It is estimated already 150,000 Ethiopian refugees have crossed the border into the Sudan at a rate of 1,500 a day, and the total number may surpass 500,000 in the Sudan alone. Neighboring Chad and other countries are expected to become affected, as well. We're talking about 150 million people in 27 countries who are or will be affected by the drought in Africa next year," Davies said.

Short-Term Solutions "Our priority is, of course, the short-term solutions of providing as much food and medical aid as fast as we can. So far Americans have donated $40 million to the relief fund in Ethiopia, and the U.S. government has made available through the Food for Peace Program 500,000 metric tons of food, with another million pledged for 1985," he said.

But that will not be enough, according to Davies. "Unless we start working with other agencies on root causes of famine--deforestation, inadequate irrigation, low level health care, poor transportation and the population pressure on land--we will see a recurrence of famine time and time again," he said.

So far, logistical problems--lack of transportation and trucks to carry foods and medical aid to remote communities and camp sites--have been a handicap. "We need 400 more trucks, which are being shipped, and massive amounts of medical supplies along with food," Davies said.

Davies admits that there is little opportunity to take on immediate projects that will improve environmental conditions, which lay the ground for infectious diseases. "It has been difficult for Western organizations to work in Communist-run Ethiopia. We have been making it loud and clear to the United Nations and Ethiopian government that food provided must be distributed wherever it is needed. So far we are satisfied that the food is getting there," Davies said.

Many Never Get Help But not all those in need are reached. "Those we are seeing are the people who are lucky enough and healthy enough to make it to camps. So far only the severely malnourished are being fed. Many others who are in need are waiting outside the camps to be admitted, and those who remain in their villages--the elderly and children--never do find help," Davies said.

A hot line has been established for those who wish information about the relief fund, whether donations are made through Inter Action or directly to individual relief agencies working in Ethiopia.

The number is: (800) 982-1400. Or, queries may be sent directly to Inter Action, 2101 L St. N.W., Washington, D.C. 20037.

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