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Malnutrition
Malnutrition
By
Prof. Kassim Al-Dawood & Prof. Manal Koura
Family and Community Medicine Department
Protein-energy malnutrition (PEM) affects every fourth child world-wide: 150 million
(26.7%) are underweight while 182 million (32.5%) are stunted. Geographically,
more than 70% of PEM children live in Asia, 26% in Africa and 4% in Latin America
and the Caribbean.
Marasmus is real starvation. There is deficiency of energy and all nutrients. It’s
primarily a disease of infancy. It’s widespread among the low socio-economic
groups of most developing countries and is much more common than
kwashiorkor.
Kwashiorkor results from deficiency of protein and to a less extent other nutrients
in the presence of adequate or even excess energy intake. It’s primarily a
condition of early life (2-3 years), but older children and adults may be affected.
Kwashiorkor in language of Ghana means: “the disease the first child gets when
the next one is on the way”.
1
Marasmus
This child was a low-birth-weight baby who remains chronically malnourished.
As a result, fat and muscle tissue are depleted, and the skin hangs in loose folds with the
bones clearly visible beneath. Hyper-alert and hungry. This child's severe wasting makes
him look like a wrinkled old man long before his time.
Growth retardation and wasting of subcutaneous fat and muscle are constant
features of marasmus. Weight is more affected than skeletal measurements, such as
length, head circumference and chest circumference. The wasting can be quantified
by measurement of the circumference of the mid-upper arm and skin folds in biceps,
triceps, sub-scapular and supra-iliac regions. It’s often evidenced by the old man or
monkey facies. Vitamin deficiencies, especially rickets (vit D) and xerophthalmia (vit
A) may be associated. The infant is often bright eyed, alert and hungry. Edema is
absent. Mild skin and hair changes and enlarged liver (common in kwashiorkor) are
occasionally present. Gastroenteritis, occurs especially in summer and leads to
dehydration. Respiratory infections are common precipitating factors in winter. TB,
severe parasitism & other chronic diseases frequently lead to emaciation.
2
Kwashiorkor
3
The liver is usually large and fatty. Iron deficiency anaemia is common, but
megaloblastosis is not rare, usually due to folic acid deficiency and Xerophthalmia
(vit. A defic.) is a frequent complication.
Prevention of Malnutrition:
1. Primary Prevention:
4
Proper nutrition of mother during pregnancy and lactation
Promotion of breast feeding
Good weaning practice
Early exposure to nutrition knowledge and desirable nutritional practice
Control of infections
Household hygiene and sanitation
Al-zakah and Al-sadakah to eliminate poverty
Emphasize the role of PHC & intersectoral cooperation for promotion of
nutrition
2. Secondary prevention:
Screening of mothers and children for nutritional problems
Early diagnosis of nutritional deficiencies
Specific intervention & treatment of nutritional disorders
Effective referral and follow-up system
Supplementary feeding programs to selective groups
Community participation