The impact of morbidity on food intake in rural Kenyan children

Objective: To quantify the effect of common illnesses on energy intake in rural Kenyan children. Design, setting and subjects: Toddlers in rural Kenya (n = 110) were studied longitudinally from 18-30 months of age in the mid-1980s. Outcome measures: Morbidity data were collected weekly using an illness questionnaire and physical inspection. Food intake was quantitatively assessed on two successive days each month. Food intake on days of illness was compared to food intake on days of wellness and during convalescence. Results: Significant decreases in mean daily energy intake were seen between days of wellness vs. days of severe illness. Above usual intake was observed during convalescence. Girls showed a greater reduction in intake during illness compared to boys. Food intake reductions were greatest in children with gastrointestinal (diarrhoea) and lower respiratory tract infections, measles and other febrile illnesses. In the case of severe illness, a compensatory increase in intake during week one of the convalescence period was observed, being greater in girls (376 kcal vs. 71 kcal extra per day for boys). Conclusion: Food intake is decreased during common acute illnesses in children and increased above their usual intake during convalescence. Food should not be withheld from sick children and feeding should be actively encouraged during illness, particularly during convalescence with the return of appetite. These data, although somewhat dated, are still applicable to toddlers in rural Africa where malnutrition and feeding practices have changed very little.