Research review

The present thesis is a descriptive study based on literature review, Researches from
previous researchers addressing the nutritional status of children under 5 years of age
and its determinants, to be reviewed. Data from available published and unpublished
literature has been reviewed.
About 4 in 10 children born to mothers with no education (37%)are stunted compared
with one in 10 of children born to mothers with secondary education. Similarly stunting
decreases with increasing wealth quintiles for 32% among children in low wealth quintile
to 17% of children in the highest wealth quintile.
On average ,Uganda women give birth to 5 children , thus straining family resources.
Childbearing begins early in Uganda , in 2016, by the age of 19, 54% of adolescent girls
has begun child bearing. This has serious consequences because children born to very
young mother are at increased risk of malnutrition, illness and death than those born to
older mothers.
The risk of stunting is 33% percent higher among first born children of girls under
18years and such early motherhood is a key driver of malnutrition . (Frink et al. 2014)

Extent of Malnutrition.
The 2 main constituents of u der nutrition are Protein Energy Malnutrition and
Micronutrient deficiency. The extent of PEM in developing countries is measured by
anthropometric data, which included 3 indicators; height for age (H/A) , weight for age
(W/A) ,weight for heigh (W/H) commonly used indicators to assess the growth status of
the children .and its these paraments that are sued to describe a child as stunted
(represents chronical malnutrition in under 2-3 years of age due to poor social economic
status, repeated infections and poor feeding practices)
wasting (indicating the recent or severe process of weight loss, associated with acute
starvation or serve disease., ) underweight (is low weight for age which reflects body
mass relative to chronological age 2.)
Body mass Index (BMI) is a popular indicator of undernutrition, it’s the weight of a
person in relation to their height and is determined by diving the body weight in
kilograms by body heigh in meter. A person with a body mass index of 18.5 and lower is
considered malnourished.

Causes of malnutitrion
Whether poor or wealthy, children are malnourished for similar reasons. Women tend to
get pregnant when young and have low birth weight babies, which predisposes children
to malnutrition
A poor dietary intake, inadequate resources and diseases such as malaria, pneumonia,
anemia, diarrhea, and HIV/AIDS (immediate cause).  Poor house hold food security,
caring practices, clean water, health system and environmental (underlying causes).
Economic factors, political factors and availability of resources, education, awareness,
policy, finance and culture. (basic cause) discussion how important understanding
culture is. For example, in some rural areas and in the past, women were not allowed to
eat chicken, eggs, or liver, which so happen to be foods that provide important nutrients.
Also, men always eat first with children eating last. In inconsiderate households,
children may be severely malnourished.
Root causes
Addressing not only the food security but also the righ food

Weak community linkages

Disorganized paitent flow

Malnutrition by itself can cause death; however, epidemiological data reveal that it
greatly increases susceptibility to and severity of infections, and is a major cause of
illness and death concomitant with numerous diseases
Malnutrition by itself can cause death; however, epidemiological data reveal that it
greatly increases susceptibility to and severity of infections, and is a major cause of
illness and death concomitant with numerous diseases (Rice AL, Sacco L, Hyder A,
Black RE 2000).
The causal relationship of malnutrition with immune suppression and infection is also
aggravated by the profound effect of many infections on nutrition itself. For example,
gastrointestinal parasites can lead to diarrhea, anemia and nutrient deprivation.
PEM is defined, in children, by measures that fall more than two standard deviations
below the normal weight relative to age (underweight), the normal height relative to age
(stunting) and weight for height (wasting). Among children aged less than 5 years in
developing countries, about 31% are underweight, 38% have stunted growth and 9%
show wasting (Müller O, Krawinkel M. 2005). Severe malnutrition occurs almost
exclusively in children and manifests as marasmus (severe wasting) marasmic
kwashiorkor (severe wasting with edema) and kwashiorkor (malnutrition with edema)
(15). Marasmus is diagnosed when subcutaneous fat and muscle are lost because of
endogenous mobilization of all available energy and nutrients. Clinical aspects include a
triangular face, primary or secondary amenorrhea, extended abdomen and anal or
rectal prolapse (16). Kwashiorkor usually manifests as edema, changes in hair and skin
color, anemia, hepatomegaly, lethargy, severe immunodeficiency and early death (17,
18).
Malnutrition increses risk fo infetionsThe strong relationship between malnutrition and
infection was originally described by Scrimshaw et al. (1968)
One-third of the world's population is infected with M. tuberculosis, the main agent that
provokes death among infectious diseases (49, 50). This infection is particularly
influenced by undernutrition and is a major cause of morbidity and mortality in
developing countries where PCM is also prevalent (51). Furthermore, malnutrition as an
important risk for tuberculosis has also being reinforced by findings in experimental
models (52). Similarly, undernutrition may also affect the clinical outcome of
tuberculosis (53).
References
Müller O, Krawinkel M. Malnutrition and health in developing countries. Can Med Assoc
J. 2005;173(3):279-86.
Rice AL, Sacco L, Hyder A, Black RE. Malnutrition as an underlying cause of childhood
deaths associated with infectious diseases in developing countries. Bull World Health
Organ. 2000;78(10):1207-21.
Müller O, Krawinkel M. Malnutrition and health in developing countries. Can Med Assoc
J. 2005;173(3):279-86.
Bhan MK, Bhandari N, Bahl R. Management of the severely malnourished child:
perspective from developing countries. Br Med J. 2003;326(7381):146-51.
. Scrimshaw NS, Taylor CE, Gordon JE. Interactions of nutrition and infection. Monogr
Ser World Health Organ. 1968;57:3-329.

Impact of malnutrition on immunity and infectionFrança TGD; Ishikawa LLW; Zorzella-

Pezavento SFG; Chiuso-Minicucci F; da Cunha MLRS; Sartori A Department of
Microbiology and Immunology, Botucatu Biosciences Institute, São Paulo State
University, UNESP, Botucatu, São Paulo State, Brazil 2009

Review

selected health units for the timely, adequate, and appropriate feeding of children, and
for improving skills of mothers and caregivers on age-appropriate caring, counseling,
and growth monitoring.

The term human-centered design (HCD) was coined by Don Norman, the Vice
President of the Advanced Technology group at Apple in 1990s. Although a new term
and concept for the world, HCD draws from the expertise of many traditional and well
developed and diverse professions including anthropology, psychiatry, investigation,
architecture, engineering, and storytelling. HCD is a thoughtful process that brings
together a diverse team and gives them a methodology to navigate complex problems
to create change.

Optimum growth in the first 1000 days of life is also essential for prevention of
overweight. Whereas attained weight at any age in early life is positively associated with
adult body-mass index in LMIC cohorts,
2

, 
 
149

, 
 
150

 rapid weight gains in the first 1000 days are strongly associated with adult lean mass,
whereas weight gains later in childhood lead mainly to adult fat mass. In particular,
evidence suggests that infants whose growth faltered in early life, and who gained
weight rapidly later in childhood, might be at particular risk of adult obesity and non-
communicable diseases.
2

Child overweight is also related to growing up in an obesogenic environment, in which

population changes in physical activity and diet are the main drivers. Modifiable risk
factors for childhood obesity are maternal gestational diabetes; high levels of television
viewing; low levels of physical activity; parents’ inactivity; and high consumption of
dietary fat, carbohydrate, and sweetened drinks, yet few interventions have been
rigorously tested.
Children are admitted as per the defined admission criteria and provided with medical
and nutritional therapeutic care. Once discharged from the NRC, the child continues to
be in the Nutrition Rehabilitation program till she/he attains the defined discharge
criteria from the program (described in technical guidelines). In addition to curative care,
special focus is given on timely, adequate and appropriate feeding for children; and on
improving the skills of mothers and caregivers on complete age appropriate caring and
feeding practices. In addition, efforts are made to build the capacity of others/caregivers
through counselling and support to identify the nutrition and health problems in their
child.

. In addition, the difficulty posed by undernutrition may fall disproportionately on the most
vulnerable members of society: pregnant women, children, and adolescents because they are
more susceptible to the harmful consequences of deficiencies e.g. adolescent girls are at high
risk for iron deficiency anemia due to accelerated growth velocity and menstruation-related iron
loss,
poor nutrition during pregnancy can actually cause changes to the DNA of a mother’s growing
children, once malnourished, babies and young children are the most vulnerable to contracting
illnesses such as pneumonia or tuberculosis
children are at the highest risk of dying from starvation.