Introduction

Malnutrition is defined as imbalance between the body’s need and the intake of nutrients
which can lead to nutritional disorders.

Malnutrition is the condition that develops when the body does not get the right amount of the
vitamins, Protein, Carbohydrates, minerals and other nutrients that needs to maintain healthy
tissues and organ function.
 CONT’D

According to WHO, Malnutrition is a cellular imbalance between the

supply of nutrients and energy and the body’s demand for them to

ensure growth, maintenance, and specific functions.

Types of Malnutrition
Under nutrition- nutrients are under supplied.

Over nutrition- nutrients are over supplied .

Under-nutrition and over-nutrition cause nutritional disorders.

 Causes of Malnutrition

Scarcity of food supply

Poor maternal health

Failure of lactation

Premature termination of breastfeeding

 Causes of Malnutrition
Poverty

Illiteracy and lack of nutrition information

Large family size

Poor environmental conditions

Adverse cultural practices

 Effect of Malnutrition on Children
Affects brain development

Protein–energy malnutrition

Disturbs growth and development

Lower immunity
 Effect of Malnutrition on Children
Failure to thrive

Small for age

Will be prone to infection

Increases the frequency and severity of infections

Methods of Nutritional Assessment
Direct and indirect methods.

 Direct methods deal with the individual and measure objective

criteria.

 Indirect methods use community health indices that reflects

nutritional influences.
Direct Methods of Nutritional Assessment
Anthropometric methods

Biochemical/laboratory methods

Clinical methods

Dietary evaluation methods

 Anthropometric method

• This method includes :

- Measuring the middle upper arm ,chest and head circumference

- Height measurements

- Skin –folds measurement

 Biochemical/laboratory method

• Biochemical assessment appears to be a reliable technique in

assessing the nutritional status of a child.

• This technique requires the testing of blood ,urine and stool samples.
 Clinical method

• Clinical assessment is carried out to detect whether the child is

suffering from hidden anemia or malnutrition .

• To check for developmental milestones such as

crawling ,walking ,speech are achieved within the normal range.

 Dietary evaluation method

• This is a group of methods that are used to collect food consumption

data to study the diets of individuals or group.

• It provides Information on food and drink consumed over a specified

time that is coded and processed to compute intakes of
energy ,nutrients and other dietary constituents using food
composition tables.
Indirect Methods of Nutritional
Assessment
Breastfeeding patterns
Type of food given to the child and frequency of feeding per day
Family ‘s food budget
Mother’s level of education
Child spacing
Father’s eating time
Method of food preparation
 Disorders Due to Malnutrition
 Protein energy malnutrition e g . Kwashiorkor and Marasmus

Obesity

 Under nutrition of vitamins and minerals

 Kwashiorkor (Under-5year)

Is a form of severe protein energy- malnutrition characterized by oedema and

an enlarged liver with fatty infiltrates. It is caused by insufficient protein
consumption.

Is a serious condition that can happen when a person does not consume
enough protein.

It can lead to fluid retention, which makes the stomach look bloated.
 SYMPTOMS OF KWASHIORKOR
Change in skin pigment

Swelling

Decreased muscle mass

Diarrhea

Failure to gain weight

Hair changes
 CONT’D

Increased and more severe infection

Moon face

 Dermatitis

Loss of muscle mass

Large belly

Irritability
Kwashiorkor
 MARASMUS
The term marasmus is derived from the Greek word Marasmus which means
Wasting’’.

Marasmus is a form of severe protein–energy malnutrition characterized by an

energy deficiency and emaciation.

Marasmus usually develops between the ages of 6 months and one year in
children who have been weaned from breast milk or suffer from chronic diarrhea
 CAUSES

Poor feeding habits due to improper training

Lack of breastfeeding

Physical defects e.g cleft lip or cleft palate

Infections

Vomiting and diarrhea

 SYMPTOMS

Severe growth retardation

Loss of subcutaneous fat

Severe muscle wasting

Wrinkled skin

Bony prominence
 SYMPTOMS

Irritability and apathy

Failure to grow and development

Dehydration

Abnormal body temperature

 Complications of Marasmus

Lack of proper growth in children

Joint deformities

Severe weakness

Permanent vision loss

Organ failure

Coma
MARASMUS
Marasmus
 Differences between Kwashiorkor and Marasmus
Kwashiorkor Marasmus
It develop in children whose diets are deficient of It is due to deficiency of protein and carbohydrate
protein
It occurs in children between 6 months and 3 years It is common in infants under 1 year of age
Subcutaneous fat is preserved Subcutaneous fat is not preserved
Oedema is present Oedema is absent
Enlarged fatty liver No fatty liver
Ribs are not very prominent Ribs become more prominent
Lethargic Alert and irritable
Muscle wasting mild or absent Severe muscle wasting
Poor appetite Voracious feeder
Needs adequate amounts of proteins Need adequate amount of protein , fats and
carbohydrates..
Marasmic - Kwashiorkor
• Marasmic – Kwashiorkor: This is the most severe form of protein-
energy malnutrition in children, with weight for height less than 60%
of that expected and with oedema and other symptoms of
kwashiorkor.
 Obesity

• Obesity is a condition where there is excess accumulation of body fat

which poses a risk to the health of the individual. It can affect children

and adult.
 Formula for Body Mass Index (BMI)
• 
 CONTD
BMI Results

Less than 18.5 Under weight

18,8----24,9 Normal

25-----29.9 Over weight

30---34 Mild Obese

35 -39.9 Moderate Obese

40 and Above Morbid Obese

Under nutrition/deficiency of vitamins and
minerals
Under nutrition of minerals

Calcium ----Rickets

Iodine deficiency----Goiter

Iron deficiency-----Anemia

Zinc -----Growth retardation

 Under nutrition of vitamins
Thiamine (Vitamin B1) - Beriberi

Niacin (Vitamin B3) - Pellagra

Vitamin C - scurvy

Vitamin D - Rickets
Thiamine (vitamin B1) Deficiency Beriberi

Weakness of eye movement, anoxia of gait, and mental disturbance.

Cardiac dysfunction such as cardiac enlargement especially right side,

oedema of intestinal tissue.

Degenerative of myelin and axon cylinders.

 Types of Beriberi
Wet beriberi generalized oedema, acute cardiac symptoms, and
prompt response to thiamine administration.

Dry beriberi oedema not present and is neurological.

 Symptoms of beriberi
Wet beriberi Dry beriberi
Shortness of breath during physical Decreased muscle function particularly in
activity the lower leg
Waking up short of breath Tinging or loss of feeling in the feet and
hands
Rapid heart rate Pain
Swollen lower leg Mental confusion
Difficulty speaking
vomiting
Involuntary eye movement
paralysis
 Riboflavin(Vitamin B2) Deficiency

Riboflavin deficiency results in stomatitis i.e painful red tongue with

sore throat and inflammation of the corners of the mouth(angular

stomatitis).
 Sign and Symptoms of Riboflavin(Vitamin B2)Deficiency

Skin disorder

Angular stomatitis

Hair loss

Reproductive problem

Itchy and red eyes

 Niacin(Vitamin B3) Deficiency Pellagra
Pellagra is a disease caused by a lack of the vitamin niacin vitamin B3.

Symptoms include: Dermatitis , diarrhea ,dementia and sores in the mouth.

Causes
 Amino acid imbalance
 Diets low in niacin
 Excessive corn consumption
 Goiter
Goiter is a swelling of the neck resulting from the enlargement of the thyroid gland.

Symptoms of a Goiter

 Noticeable swelling of the neck

 Difficulty in swallowing or breathing

 Coughing

 Hoarseness in your voice

 Dizziness when you raise your arm above your head.

 IRON DEFICIENCY ANAEMIA

Iron deficiency anemia is a common type of anemia

caused by insufficient dietary intake and absorption of iron ,and or iron loss from
bleeding
 Rickets
Rickets is the softening of bones in children due to lack or inadequate intake of vitamin
D, phosphorous or calcium.

 Rickets is most common in children who are between 6 and 36 months old.

Symptoms of Rickets

 Pain or redness in the bones of the arms ,legs .pelvis or spine

 Stunted growth

 Bone fractures

 Muscle cramps
 Prevention of Malnutrition

Primary Prevention

 Health Education

 Immunization

 Growth monitoring on charts

 Prevention of Malnutrition

Secondary Prevention
 Mass Screening of high risk populations using simple tools like Weight
for age or MUAC

Tertiary Prevention
 Good nutritional care, supplementary feedings, rehabilitation and
Counselling of mothers
THANK YOU