Marasmus is a severe form of malnutrition that consists of the chronic wasting

away of fat, muscle, and other tissues in the body. Malnutrition occurs when your
body does not get enough protein and calories. This lack of nutrition can range
from a shortage of certain vitamins to complete starvation. Marasmus is one of the
most serious forms of protein-energy malnutrition (PEM) in the world also in
Indonesia.

Marasmus is a serious problem and is most common in children in developing

regions, such as Africa, Latin America, and South Asia, where poverty, along
with inadequate food supplies and contaminated water, are prevalent.
Contaminated water may contain bacteria or parasites that enter the body when
the water is consumed and cause infections that complicate the condition.

In general, Indonesian society have been able to consume enough food

quantitatively. But in terms of qualitative still quite a lot that has not been able to
meet the minimum nutritional needs.
The Department of Health has mapped and the results show that patients with
malnutrition was found in 72% of districts in Indonesia. The indication 2-4 of 10
toddlers in Indonesia suffer from malnutrition. Children with this condition have
lost a lot of muscle mass and subcutaneous fat. Subcutaneous fat is the layer of fat
just under the skin. Dry skin and brittle hair are also symptoms of marasmus.In
children with marasmus, the following can also occur: chronic diarrhea,
respiratory infections, intellectual disability, stunted growth. Seriously
malnourished children may look older and have little to no energy or enthusiasm
for anything. Marasmus can also make children short-tempered and irritable.

The main cause of marasmus is less calories protein that may occur due to: the
diet is insufficient, inappropriate eating habits such as the parent-child
relationship with a troubled, because abnormalities metabolic, or congenital
malformations. The factors that cause the occurrence of marasmus, among others:

1. Protein Diet (and amino acids) is the substance that is necessary for
children to grow and develop. Although the intake food contains
enough calories, not all foods containing protein/amino acids. Diet the
less energy can also lead to the occurrence of marasmus.
 2. Population density, marasmus is found in great numbers due to an area
too densely populated with bad hygiene.
3. Social Factors social Circumstances are unstable, or the existence of
restrictions for use of certain ingredients and has maintained its
position from generation to generation can be the thing that causes the
occurrence of marasmus.
4. The Educational Factor in the lack of knowledge about the importance
of nutrition among the community that her education relative low.
5. Economic factors Poverty, low income families who can not meet the
need and the inability in purchasing foodstuffs resulted in a balance of
nutrients a child that is not met, when his mother was not able to
fullfill the needs of protein.
6. Infectious disease and other Factors, there is a synergistic interaction
between the MEP (protein-energy Malnutrition) and infection. Any
degree of infection can worsen the State of nutrition. Severe infection
can worsen the State of nutrition through the disturbance of input and
meningginya loss of essential nutritional substances the body. MEP
and vice versa, although in mild degrees will lower the immunity of
the body against infection. Marasmus can also occur due to a variety of
other diseases such as diarrhea, often attacked the digestive tract
congenital abnormalities or heart, malabsorption, metabolic disorder,
chronical kidney disease and also disorders of the central nervous.

Marasmus can occur at any age. In children, usually causes occurrence of

marasmus is caused because no fulfillment breast milk when baby. Besides
environmental factors, there are several other factors on children's own self being
carried from birth, thought to have an effect on the occurrence of marasmus.

Growing up in a developing country is a risk factor for marasmus. Areas

that have famines or high rates of poverty have higher percentages of children
with marasmus. Nursing mothers may be unable to produce enough breast milk
due to malnutrition. This affects their babies.
 Viral, bacterial, and parasitic infections can cause children to take in too
few nutrients. Regions with high disease rates and insufficient medical care may
also have other factors that reduce the chances of people having enough food to
eat.

The protein energy malnutrition in marasmus, if left untreated may

complicate to either of these medical conditions: mental retardation, physical
disability, renal failure, pneumonia, heart failure, sepsis, electrolyte imbalance,
severe vitamin deficiency states, metabolic disturbances, and also can lead to
death. There are some ways to prevent marasmus in children, among others, as
follows:

1. Exclusive breastfeeding (breast milk only) until the child is 6 months

old. After that, children began to be introduced with the extra food as
weaning according to age levels, then weaned after 2 years old.
2. Children are given a varied diet, balanced between protein, fat,
vitamins and minerals. Comparison of composition: to fat of at least
10% of the total calories needed, while the remaining 12% protein and
carbohydrates.
3. Diligent weigh and measure the height of a child by following the IHC
program. Observe whether the growth of the child in accordance with
the standards above. If it is not, immediately consult the doctor.
4. If the child is hospitalized due to poor nutrition, can ask the clerk
pattern and type of food should be given after discharge from the
hospital.
5. If the child has suffered from malnutrition, then immediately give high
calories in the form of carbohydrates, fats, and sugars. As for the
protein can be given after other caloric sources already seen able to
increase the energy of children. Give all mineral supplements and other
essential vitamins. Early treatment often produce good results. On
condition that is severe, therapy can be done by improving the general
health condition.
However, it will usually leave residual symptoms permanent physical
abnormalities and will appear in a later issue of intelligence.
Such efforts require health facilities and infrastructure that are good for health
services and nutrition counseling. Breastfeeding (ASI) to age 2 is the energy
source of the most good for the baby. Coupled with additional nutritious feeding
at age 6 years and over. Prevention of infectious diseases, to improve
environmental hygiene and personal hygiene, immunization, and following the
family planning to prevent pregnancy too often. Counseling / nutritional education
about adequate feeding a long-term prevention efforts. Monitoring (surveillance)
is regular in children in endemic areas of malnutrition, by weighing each month.

Initial treatment of marasmus often includes dried skim milk powder

mixed with boiled water. Later, the mixture can also include a vegetable oil such
as sesame, casein, and sugar. Casein is milk protein. The oil increases the energy
content and density of the mixture.

Once a child starts to recover, they should have a more balanced diet that
meets their nutritional needs. If dehydration is a problem because of diarrhea,
rehydration should also be a priority. A child may not necessarily need fluids
delivered intravenously. Oral hydration may be sufficient. Also infections are
common among children with marasmus, so treatment with antibiotics or other
medications is standard. Treating infections and any other health issues can help
give them the best chance of recovery.

With proper nutrition and medical care, the outlook can be a positive one. Relief
workers can provide food and healthcare to regions where marasmus and other
malnutrition problems are common. The best outcomes occur when a child’s
parents or guardians know about the importance of nutrition and how to prepare
foods properly. Healthy weight gain and growth can resume fairly quickly once a
child with marasmus starts consuming more calories, protein, carbohydrates, other
nutrients.
 From the explanation above, we can conclude that marasmus is one form
of malnutrition that is often encountered in children. Symptoms look flashy and
multifactorial causes include lack of food intake, disease factors and
environmental factors, ignorance to choose nutritious foods, unfavorable
economic conditions, etc. Diagnosis based on clinical features necessary to
determine the cause of the history of food and other diseases. Marasmus cases in
children - the child is still a lot going on in Indonesia, especially in communities
with low economic level. Prevention of marasmus intended to cause and require
health care and good extension. Treatment of marasmus is the provision of a diet
high in calories and high in protein and management in hospitals that should be
done regularly and controlled.

Bibilography

http://carenlee.newsvine.com/_news/2012/02/24/10493691-marasmus-causes-
symptoms-and-treatments

https://www.symptoma.com/en/info/marasmus

http://www.healthline.com/health/marasmus#Outlook7