Kwashiorkor, one of the most extreme forms of malnutrition, is estimated to affect more than a hundred thousand children annually. The condition can make a starving child look healthy to the untrained eye, which makes it difficult to study and track. As a result, it has largely been overlooked by the scientific community. Researchers have recently attempted to increase its recognition by conducting a global study of more than 1.7 million children, but a new study published in the Food and Nutrition Bulletin reveals that kwashiorkor may be a local phenomenon that is underestimated by national statistics.

Out today, the study concludes that analyzing data on a large, global scale carries dangerous risks:

Nutrition researchers from Tufts University, Harvard University, and St. Johns Research Institute conducted a comprehensive survey of a geographic area including more than 1,300 children aged one to five years in the Democratic Republic of the Congo (DRC). A previous study conducted globally had suggested that 33 percent of malnutrition cases in the DRC were of the kwashiorkor variety but that this was higher in some provinces than others. Hoping to better understand this dynamic, the researchers comprehensively surveyed 19 neighboring villages to understand the prevalence of the disease at the local level.

Their results found that rates of kwashiorkor varied from 0 to 14.9 percent in these villages, the latter number indicating extreme nutritional stress within specific communities. The difference between different areas, which appeared statistically identical, was extreme: one group, or “cluster,” of five adjacent villages had no cases of kwashiorkor, while in a neighboring cluster of five villages, 9.5% of children had the condition. By interviewing health service staff members in the region and reviewing the nutritional history of the children, the researchers were able to confirm that these numbers reflect a long-term pattern.

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