The authors declare that they have no conflict of interest.
Malnutrition and anemia are an important cause of morbidity and mortality in Colombia and the world. Among the causes and/or risk factors can be related to ethnic and indigenous groups, which due to their customs and beliefs are a limitation to consult health centers and, on the contrary, turn to individuals with a social prestige within a community “shaman” in search of therapeutic behaviors, which is a barrier to the health system and a public health problem.
To present the clinical case of an adolescent patient with fatal outcome due to inadequate management of severe anemia and severe malnutrition.
17-year-old teenager, lived with her elderly parents in a rural area, was found at home with altered consciousness, unquantified fever, global headache, and epistaxis, referred with a diagnosis of severe anemic syndrome with hemoglobin of 3.3 g/dL, and severe malnutrition. He was admitted to the emergency room in cardiorespiratory arrest, advanced resuscitation maneuvers were started, but no vitality response was obtained, declaring death.
The management of anemia in rural areas is carried out through different beliefs and cultures that are transmitted from generation to generation, which involve a series of baths, concoctions, ointments, and salves, which due to lack of knowledge of the families go to empirical healers in the regions to perform mixtures of plants or rituals to heal the symptoms, omitting the importance of seeking timely care at medical centers.
La desnutrición y la anemia son una causa importante de morbimortalidad en Colombia y el mundo. Entre las causas y/o factores de riesgo se pueden relacionar a grupos étnicos e indígenas, que por sus costumbres y creencias son una limitante para consultar a los centros de salud y, por el contrario, acuden a individuos con un prestigio social dentro de una comunidad “chamanes” en busca de conductas terapéuticas, lo cual es una barrera para el sistema de salud y un problema de salud pública.
Presentar el caso clínico de un paciente adolescente con desenlace fatal por manejo inadecuado de anemia grave y desnutrición severa.
Adolescente de 17 años, convivía con sus padres adultos mayores en área rural, fue encontrado en su domicilio con alteración de estado de conciencia, fiebre no cuantificada, cefalea global y epistaxis, remitido con diagnóstico síndrome anémico severo con reporte de hemoglobina de 3.3 gr/dl y desnutrición severa. Ingresó a urgencias en paro cardiorrespiratorio, iniciaron maniobras de reanimación avanzada, sin obtener respuesta de vitalidad, declarando la muerte.
El manejo de cuadros anémicos a nivel rural es realizado mediante diferentes creencias y culturas que son trasmitidas de generación en generación, las cuales involucran serie de baños, brebajes, ungüentos y ensalmes, que por desconocimiento de las familias acuden a curanderos empíricos de las regiones a realizar mezclas de plantas o rituales para sanar los síntomas, omitiendo la importancia de acudir a una atención oportuna a centros médicos.
Malnutrition is a silent disease that affects millions of children in Colombia and the world
In the United States, iron deficiency was reported in 9% of children aged 12 to 15 years and 16% in children aged 16 to 19. In India, a 15% prevalence of anemia has been reported among 18-year-old adolescent girls due to poor nutrition
According to the survey conducted by the Colombian Institute of Family Welfare (ICBF) in 2015, chronic malnutrition affected 1 in 10 adolescents, 36.5% were Indigenous, 14.9% of the population in poverty, and 15.7% rural areas (5) being child malnutrition one of the consequences of iron deficiency anemia and a condition that affects cognitive development in early childhood, adolescence, and even adulthood
Culture between generations proportionally influences people's quality of life and children's development and growth. A Peruvian study found that 80.0% of mothers have dietary beliefs that lead to child malnutrition. More than 70% of people do not include proteins or vitamins in their diet. Having children at an early age, low schooling, poor income, and occupation are factors that contribute to the increased prevalence of chronic malnutrition, which, according to the World Health Organization, is responsible for 3.5 to 5 million deaths/year
Like malnutrition, the development of anemia may be influenced by the customs and medical practices performed by indigenous "healers" which is a barrier to health systems use
This article aimed to present a clinical case of an adolescent patient with a fatal outcome associated with inadequate management of severe anemia and severe malnutrition.
A 17-year-old male with a history of severe anemia (hemoglobin 3.3 g/dL), he lived in a rural area with elderly parents, worked in a corn field, and was in eighth grade. His diet was basic carbohydrate-based with occasional protein intake. A brother reported seeing him with a progressive decrease in weight and generalized pallor.
On multiple occasions, he was taken to the "
He was found at home with altered consciousness, unquantified fever, and epistaxis. At the first level of care, they documented severe malnutrition and severe anemia. He was referred to a higher level of care for a six-hour picture of asthenia, adynamia, moderate intensity global headache and epistaxis.
On admission, he was tachycardic (heart rate 134/pm), with blood pressure 118/75 mmHg, temperature 36.2 °C, weight 34 kg, height 1.64 cm, body mass index 12.6 kg/m2, hypertrophic extremities and multiple ulcerative lesions in lower extremities. During admission, he presented asystole, Glasgow 3/15. Advanced resuscitation maneuvers, red blood cell transfusion, and orotracheal intubation were started, and several minutes later, the patient died.
It was considered to be a clinical condition due to social neglect and child abuse that led to an acute chronic process of severe anemia of unknown cause and severe malnutrition due to nutritional deficiency.
Malnutrition is a prevalent childhood disease related to low food intake
Other risk factor is low educational level, which leads to determining that lack of education increases the probability of developing metabolic and nutritional diseases
The ENSIN 2015 report documented that the departments with global malnutrition in Colombia are: Guajira (11.0%), Chocó (6.3%) and Guainía (6.1%), while chronic malnutrition amounted to 10. 8%, which for 2013 presented 19 deaths
It has been analyzed whether anemia is caused by culinary dietary practices or cultural beliefs, given that the rural diet in African countries is predominantly vegetarian. In Awajún and Wampis communities in Peru, anemia is known as
In Colombia, the reality is similar: indigenous communities continue to perform traditional practices and attend clandestine consultations with individuals with social prestige within a community of "shamans" in search of informal therapeutic behaviors for anemia and malnutrition. Although these beliefs do not have solid scientific evidence, they have been modified by situations typical of a country where, throughout its history the armed conflict, territorial disputes and criminal gangs have caused these populations to migrate to large cities with unfavorable conditions and little possibility of improving their living conditions
Healers, also known as shamans or
The use of medicinal plants differs by region, ethnic, and racial group. Ruiz Lurduy et al.
Although the type of herbs used in the traditional practice "panto baths" was not known in the present clinical case, Satheesh et al.
Diogo et al.
The authors of this article consider that there are still significant limitations in the general population, and even more so in rural areas, to receiving health care and fulfilling fundamental human rights, possibly influenced by the customs or beliefs of some communities. It is pertinent that governments show great interest in public health to orient these communities to have more excellent proximity and trust with the health sector and thus to go to health centers promptly to reduce morbimortality due to potentially preventable causes.
Inherited practices, beliefs, and the lack of nutritive food necessary for development and growth cause the death of patients due to the lack of timely attendance to general medicine. Due to a lack of knowledge or the distance of transportation to health centers, families in rural areas use alternatives to control their ailments, such as infusions, herbal baths, and consulting healers in the hope of a favorable recovery.