The Kabezi district hospital is located in the west of the country, in the Kabezi commune, Migera zone on Kabezi hill in the province of Bujumbura. It is located at the following geographical coordinates: Latitude (3˚32'00"), Longitude (29˚20'32"), Altitude (790 m). The Kabezi health district serves a total population of 273,641, 15.5% of whom are children under 5 years old (Burundi). It is made up of 30 different health facilities ( Table 1 ).

This study was carried out at the Therapeutic Stabilization Service (SST) of Kabezi Hospital with children under 5 years of age suffering from severe acute malnutrition coming for consultation for their nutritional care. The study was carried out for 7 months, from May to November 2021. It concerned the collection of data from previous years (from 2015 to 2020) plus data from 2021.

This was a descriptive cross-sectional study with retrospective data collection.

Included in the study are all the files of children under 5 years of age admitted to the therapeutic stabilization service suffering from severe acute malnutrition during the study period.

The following are not included in the study:

The data were collected from the hospitalization records of severely malnourished children from 2015 to 2021 and by taking anthropometric (height and weight) measurements of children referred to the Outpatient Therapeutic Service (STA) and in consultation. The data to be collected concerned all of the child’s anthropometric measurements: age, weight, height. All data on children admitted and registered at the STA from 2015 to 2020 were collected from the hospital registers. For 2021, the year of the study, they were collected on site as they were admitted to the STA. Thus, from 2015 to 2020, 99, 70, 76, 60, 80, and 60 children were registered respectively. In 2021, 53 were registered ( Figure 1 ). Which gave a total of 498 children.

The survey was only conducted after obtaining the consent of the administration of the structure and the mother or accompanying person according to the consent proposal in the preamble to the survey form. In order not to disseminate medical confidentiality by revealing the identity of the child and medical data, each child was represented by a number.

Data analysis was performed using IBM SPSS statistic 20. Results were analyzed using one-way analysis of variance (ANOVA) followed by Tukey’s multiple comparison test. Correlation between various parameters was also investigated. Significance was determined at p < 0.05 level and the results were expressed as mean values ± standard error (SE). All tests were performed in triplicate.

The Kabezi District Hospital serves an area of responsibility of 23 Health Center. Throughout 2021, 9 Health Center (or 39%) were able to transfer children to the Therapeutic Stabilization Service (SST) of the Kabezi hospital ( Figure 1 ). We focused on the current year of study, to see the area where malnutrition still persists. The results show that the Kabezi Health Center was the one that referred more malnourished children at a percentage of 37.5% of the total number of patients referred to the Kabezi health district hospital in 2021. The Muyuyu, Magara and Mubone sites referred only one patient each, which was equivalent to a percentage of 2.08%. Looking at these results, it is clear that there are many children who will have a poor future. Undernutrition affects the development of the child’s brain, impairing learning and future earning capacity [15] . These conditions increase child mortality, deepen poverty, create profound intergenerational disadvantage, and hinder a country’s economic future. Goal 2 of the Sustainable Development Goals (SDGs) calls for ending malnutrition in all its forms by 2030 [16] .

The word marasmus comes from the Greek “marasmos” which means drying out. It can also mean athrepsia, starvation and sometimes used as a syndrome of [17] . According to the same author, marasmus is associated with nutritional deficiencies of folic acid, copper, iodine, vitamin A, vitamin B, vitamin C, vitamin D and vitamin K. This study revealed that since 2015 the number of marasmic children has decreased ( Figure 2 , curve E0). If the situation continues to improve at this rate (trend line = Y = −1.9119x + 3912), there will be 0 cases of marasmus in 2046. This is in line with the government’s view that the country will be emerging in 2040. However, from 2021 to 2046, 20 years ago, which shows that there will be many people who have suffered from poor growth. This affects the country’s overall development. Studies have reported that a child under 3 years old who has suffered from malnutrition diseases has poor growth, and weak intellectual and cognitive development cognitif [18] [19] . This implies that the government will have to take all possible measures to reduce cases of marasmus to zero as quickly as possible.

Kwashiorkor and marasmus are two clinical syndromes observed in severe acute malnutrition. The depletion of antioxidants, vitamins and minerals was more severe in kwashiorkor than in marasmus. This was consistent with the severe and uncontrolled oxidative stress associated with the depletion of intestinal anaerobic bacteria and the relative proliferation of intestinal aerotolerant bacteria [20] [21] .

Kwashiorkor syndrome, one of the most common and severe forms of protein-energy malnutrition, is characterized by significant edema, skin and hair changes, neurological abnormalities, and hepatic steatosis [22] . In this study, the identification of children with Kwashiorkor was done based on the different presence of edema. Figure 2 shows that edema can manifest in three ways: on one part of the body (usually on the cheeks, arms, legs) (E1), on two parts of the body (E2) and on three parts of the body (E3). This study revealed that during this entire period children presenting edema on three parts of the body are always high.

Highly significant differences (p > 0.05) were observed for a given year in this order: E3 > E2 > E1. This cannot directly explain why there are few children who present these signs on a body part, rather it is probably due to the fact that the population seeks health care facilities late. Based on the equation of the trend curve (y = −0.8571x + 1732.3), we see that the number of children with edema on one side would have been zero in 2021. However, this is to be treated with an eye. Opposite phenomena have been observed in children with edema on two sides. Instead of evolving positively, the number of patients increases over the years. The trend curve is an increasing linear function (y = 2.8289x − 5689.8). Although the numbers are high in children with edema on three sides, we realize that the patients decrease over time. However, to reach zero cases of children with edema on three sides will take a long time. According to this trend equation (y = −1.9119x + 3912.8), the disease will end in 2046. By comparing the “curves” (E1, E2 and E3), patients go to the hospital after noticing edema on two parts of the body.

Birth weight shows the nutritional status of the child and the mother at the time of conception. It also indicates the speed of the child’s growth after birth and has repercussions on the child’s life [23] . The results show that, during the 7 years, children under 5 years of age in the Therapeutic Stabilization Service of the Kabezi health district hospital were characterized by a state of malnutrition. A positive correlation was observed between BMI and age for both girls and boys for the years 2015, 2016, 2017 and 2021, for boys only the year of 2018, for girls only the year of 2019 and 2020 ( Figure 3 ). Based on the WHO Child Growth Standards curve based on length/height, weight and age [24] , it was revealed that at the corresponding age, the children of the therapeutic center are very far from the average. For example, at 10 months WHO stipulates that BMC varies from 13 to 20 [24] , while these children of Kabezi vary from 5 to 15 ( Figure 3 ). In addition to the results on marasmus and kwashiorkor, these data on BMI, provide concrete information on the nutritional status of children. The trend of BMI in developing countries instead of turning into underweight is turning into overweight. At the time when the average BMI was 14 kg/m², in Peru it was 18 kg/m² [25] . The nutritional status of these children being lower than the average, intertropical climate characterized by great biological diversity; which supposes that in Kabezi can grow diverse plants. In addition, Kabezi touches Lake Tanganyika which contains a multitude of fish. Thus, whether it is breastfeeding mothers or infants, there are fewer products of diversified and nutritionally rich foods. Studies have reported that even natural forest ecosystems can provide food to diversify. A dozen plant species were found with significant contents of oils of different composition including omega 3 and 6 [26] [27] essential for the development and growth of the child. Through these same results, it was revealed that the years 2018 (for girls), 2019 (for boys), 2020 (for boys) were characterized by a negative slope, which supposes that a small evolution was recorded according to age. However, there is no scientific justification for this state of affairs, or there is an evolution either in girls only or in boys only.

Since 2015, cases of children suffering from malnutrition diseases have been observed that persist. The average BMI for these children decreased over the years ( Figure 4 ). This last table shows us that those who were sick never exceeded the BMI of 14.5 kg/m² during the 7 years. The evolution since 2015 has been characterized by a deterioration in the health of children under 7 years. Since we do not have such data available for Burundi for comparison, let us talk about the average BMI of other countries to give us an idea. In 2016, the BMI in Ethiopia was 16.6 kg/m², in India it was 17.5 kg/m², in Peru 20.8 kg/m² and in Vietnam 18.7 kg/m² [25] . In this present study of Burundi, in the same year of 2016, very low values of BMI (12.8 kg/m²) were recorded in patients. Probably these results were the consequence of the crisis that the country experienced in 2015 [28] [29] . In the 4 years (2017, 2018, 2019 and 2020) that followed, a small improvement was observed where the average had turned around 13 kg/m². Surely, there are many causes that prevent the provision of sufficient food such as the smallness of the land, the population that increases at a galloping pace and others. It was also noted that like 2016 which followed a crisis of 2015, 2021 which followed the electoral periods were also characterized by very low BMI values (12.4 kg/m²).