Saru Saud, 7, husks corn outside her home, in the western reached of Nepal. Here, UNICEF-supported community health volunteers visit Saru’s village to screen children for malnutrition.
What is malnutrition?
How is malnutrition assessed?
What are the stages of malnutrition?
How is malnutrition treated?
WHAT IS MALNUTRITION?
Malnutrition is the state of being poorly nourished. It is not merely a result of too little food, but of a combination of factors: insufficient protein, energy and micronutrients, frequent infections or disease, poor care and feeding practices, inadequate health services and unsafe water and sanitation.
Malnutrition robs children of vital micronutrients that are essential to their growth and development, and makes them more susceptible to disease. Where it does not kill, malnutrition can leave permanent scars. It can leave a child physically and intellectually damaged and suffering from the consequences of a weakened immune system.
Malnutrition’s most devastating impact is in the womb – when the foetus can fail to develop properly – and during the first years of a child’s life, when it can hamper his or her physical and mental development.
HOW IS MALNUTRITION ASSESSED?
The most common way to assess malnutrition in children is through body measurements. It is usually diagnosed in one of three ways:
• Weighing a child and measuring his or her height;
• Measuring the circumference of the mid-upper arm; or
• Checking for fluid retention or swelling in the lower legs or feet.
A sleeping child’s upper arm is measured by a nurse during a UNICEF-assisted nutrition screening in Kenya.
The child’s weight is compared to the ‘normal’ weight for that height. Normal weights for children are determined by studies that have weighed thousands of healthy children. Based on this information, the World Health Organisation (WHO) has developed charts known as international standards for expected growth.
Measuring mid-upper arm circumference
A mid-upper arm circumference (MUAC) measurement band has different colours along the strip. If the arm band lands in the orange section it means the child is suffering from moderate acute malnutrition. If it lands in the red section, about the size of a 20c coin, the child is suffering from severe acute malnutrition.
Testing for oedema
A third way of diagnosing acute malnutrition is by testing for the presence of oedema. Oedema affects a child’s appearance, giving him or her a puffy, swollen look in either lower limbs and feet or face. It can be detected by small pits or indentations remaining in the child’s lower ankles or feet, after pressing lightly with the thumbs. The presence of oedema in both feet and lower legs is always considered a sign of severe acute malnutrition.
THE STAGES OF MALNUTRITION
Malnutrition takes different forms and a child can be affected in several ways simultaneously.
Moderate Acute Malnutrition (MAM)
is used to describe children who are suffering from wasting (low weight-for-height ratio) or stunting (low height-for-age ratio) or a combination of both.
Children suffering from MAM have an increased risk of mortality and MAM is associated with a high number of nutrition-related deaths. If these children do not receive adequate support, they may progress towards Severe Acute Malnutrition and/or severe stunting, both of which are life-threatening conditions.
Children suffering from MAM are given a course of special therapeutic food such as Plumpy’nut.
Severe Acute Malnutrition (SAM)
is defined by a very low weight for height, by visible severe wasting or by the presence of nutritional oedema.
Children suffering from SAM receive therapeutic milk and Ready-To-Use Therapeutic Food (RUTF) to stabilise their medical condition. After three or four days, the milk can usually be replaced by Plumpy’nut to help them recover over the following weeks.
WHAT IS PLUMPY'NUT®?
Plumpy’nut® is frequently used as a treatment for emergency malnutrition cases. It helps with rapid weight gain, which can make the difference between life and death for a young child. The product is also easy for children to eat since they can feed themselves the soft paste. The fortified peanut butter-like paste contains a balance of fats, carbohydrates and proteins (macronutrients), and vitamins and minerals (micronutrients).
Plumpy’Nut® is a registered brand from Nutriset.
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WHAT IS THERAPEUTIC MILK?
Therapeutic milk is special milk used when a child is too weak to swallow RUTF. The child receives a specific quantity of milk based on weight, in a strict feeding frequency, including during the night, in order to restore the metabolism.
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