Childhood Malnutrition

in Developing Countries
Definition:
Malnutrition is a nutritional imbalance resulting in undernutrition (underweight,
wasting, stunting), micronutrient deficiencies and overweight.
Acute Malnutrition

Clinical features:
• Low weight for height
• Wasting (Marasmus)
• Oedema (Kwashiorkor)

Causes:
• Illnesses
• Infectious diseases
• Food deprivation due to seasonal
shortages
• Sudden catastrophes

Effects:
• Weakened immunity
• Long-term developmental delays
• Increased risk of death
Chronic Malnutrition

Clinical features:
• Low height for age
• Stunting

Causes:
• Poor socioeconomic conditions
• Poor maternal health
• Frequent illnesses
• Inappropriate infant and young child
feeding and care in early life

Effects:
• Physical and cognitive disabilities
Classification of protein
energy malnutrition
Wellcome classification

A qualitative classification of protein-energy malnutrition in children based on percentage of expected

weight for age and the presence or absence of oedema.
 Waterlow Classification

A quantitative classification of protein-energy malnutrition in children based on the degree of wasting

and stunting.

Expected weight for height = x 100%

Expected height for age = x 100%

Normal Mild Moderate Severe

Expected 90 80-90 70-80 70
weight for
height (%)
Expected 95 90-95 85-90 85
height for
age(%)
Interventions to improve
nutrition and child survival
Interventions in the critical window of the first 1,000 days of life can make all the difference, these
include:

• Adequate maternal nutrition before and during pregnancy and lactation

• Optimal breastfeeding in the first two years of life

• Nutritious, diverse and safe foods in early childhood

• A healthy environment, including access to basic health, nutritious food, water, hygiene and
sanitation services and opportunities for safe physical activity
Successful interventions
Commercial fortification of staple foods with micronutrients

Universal salt iodization (between the early 1990s and 2016):

• Led to a major decline in iodine deficiency disorders of
goitre and cretinism.

• Improved the intellectual development of millions of

children.

• Caused the number of countries in which iodine deficiency

is a public health problem to fall from 113 to just 19.16.
United States
1942:
• Fortification of milk with vitamin D to prevent rickets.

1996:
• Addition of folic acid to flour to reduce the prevalence of neural tube defects, such as spina
bifida and anencephaly, a fatal condition.
• Subsequent assessments demonstrated that the prevalence of neural tube defects had
decreased by 19–32 per cent.
Communication campaign around feeding practices

Cambodia, Rwanda and India

Intensive and sustained communication campaign around feeding

practices increased the rates of early initiation of breastfeeding.
Improvements in the water, sanitation, hygiene system
(WASH)
Pakistan and Ethiopia

Interventions that prevented stunting and other forms of malnutrition

included:
• maintaining safe water supplies
• encouraging community-based approaches to eliminate open defecation
• improving hygiene behaviour
Adolescent anaemia control programme
India
The adolescent anaemia control programme showed how the education
system can work to scale up nutrition-specific results.

After a year, the programme reported a significant decrease in the prevalence

of moderate to severe anaemia.
Cash transfer programs
Brazil
A nutrition-sensitive social protection programme utilizing conditional cash
transfers has reduced malnutrition related child mortality.

Pregnant and lactating women receive cash transfers on condition that

they attend pre- and post-natal appointments and participate in
educational activities on nutrition and health.
Mexico
Conditional and unconditional cash transfers, food rations and school feeding, can all help limit the
long-term effects of deprivation and provide communities with the means to access and afford
nutritious food.

Cash-transfer programmes, in particular, have proven benefits for the nutritional status and health
outcomes of children.
Take home message

• Childhood malnutrition is a major health burden in developing countries as good nutrition is

important for children to survive, grow, develop and learn while malnutrition robs children of
their futures.

• We as future doctors must play a part in identifying malnourished children and support them
through immediate treatment and counselling.

• Combating malnutrition is a team effort and a systems approach is crucial in improving

nutrition and child survival.
References:
1. World Health Organization [Internet]. Geneva: World Health Organization, United Nations
Children’s Fund (UNICEF), International Bank for Reconstruction and Development/The
World Bank. Levels and trends in child malnutrition: key findings of the 2019 Edition of the
Joint Child Malnutrition Estimates; 2019 March [cited 2020 March 2]. Available from:
https://www.who.int/nutgrowthdb/estimates2018/en/

2. UNICEF [Internet]. UNICEF, New York. The State of the World’s Children 2019. Children,
Food and Nutrition: Growing well in a changing world; 2019 [cited 2020 March 2]. Available
from: https://www.unicef.org/reports/state-of-worlds-children-2019

3. Waterlow JC. Classification and definition of protein-calorie malnutrition. British Medical

Journal. 1972;3(5826):566.

4. Bender DA. Wellcome classification. 4 ed: Oxford University Press; 2014.

5. Bender DA. Waterlow classification. 4 ed: Oxford University Press; 2014.

 
Stunting increased from 17.2% in 2006 to 20.7% of all children below five in 2016, while 13.7%
of children were underweight in 2006. Micronutrient deficiencies pose a great threat but are
frequently neglected.