Introduction
Marasmus is a serious worldwide problem that involves more than 50 million children younger than 5 years. According to world Health Organization (WHO), 49% of the 10.4 million deaths occurring in children younger than 5 years in developing countries are associated with protein energy malnutrition (PEM).
Malnutrition has been permanent priority of the WHO for decades. Although a higher proportion of several malnourished children do not survive a significant undercurrent illness as much as 80% of the overall unacceptably hilly – mortality rate may be contributed by mild to moderately malnourished children because this co hart is so much higher (Joosten & Hulst, 2008)
Marasmus is a form of severe malnutrition characterized by energy deficiency. A child with miasmas looks emaciated and body weight is reduced to less than 60% of normal (expected) body weight for the age (Appleton & Vanbagen, 2013)
According to Badaloo (2006), marasmus occurrence increases prior to age 1, whereas kwashiorkor occurrence increases after 18 months. It can be distinguished from kwashiorkor in that kwashiorkor is protein deficiency with adequate energy intake while marasmus is inadequate energy intake in all forms including protein.
The malnutrition associate with miasmas leads to extensive tissue and muscle wasting as well as variable oedema. Other common characteristics including dry skin loose skin folds lagging over the buttocks and armpit, drastic, loss of adipose tissue irritability and voracious hunger.
Definition of marasmus
The word marasmus comes from the Greek marasumos meaning decay. This can be describes as the wasting away or atrophying of the body in the absence of disease.
Webster’s college Dictionary (2010) define marasmus as a malnutrition occurring in infants and young children, caused by insufficient intake of calories or protein characterize thinness, dry skin, poor muscle development and irritability.
Marasmus is the progressive wasting of the body, occurring chiefly, in young children and associated with insufficient intake or malabsorption of food. It occurs in young in developing countries, particularly under famine conditions, in which a mother’s milk supply is greatly reduced (American Heritage Dictionary, 2009).
Marasmus is characterized by growth retardation and progressive wasting of subcutaneous fat and muscle as well as diarrhoea and dehydration.
Causes of marasmus
Marasmus is caused by a severe deficiency of nearly all nutrients, especially protein and carbohydrates (WHO, 2002).
According to Pawellek, Dokoupil and Koletzko (2008) several factors can lead to marasmus, their relative importance varies between children and between parts of the world for example, Undernutrition associated with war, inappropriate weaning by a young mother and precipitating infection can
Influence incidence of marasmus.
- Nutrition: In many low income countries, food variety is limited and the results in mineral and vitamin insufficiencies therefore, any nutrient deficiency can lead to marasmus because appropriate growth can only be ensured by a balanced diet. Thus marasmus can be described as multiple deficiency malnutrition.
- Infection: Associated often triggers aggravate, or combined with marasmus, however evidence exists this association may have been overestimated. The importance of diarrhoea in triggering malnutrition though anorexia and weight loss has been well established, Infection disease are more frequently associated with energy protein, malnutrition are gastroenteritis, respiratory infection, measles and pertus. HIV also plays an increasingly significant role in some countries.
- Socio-economic factors: Frequently malnutrition appears during weaning especially if weaning is suboptimal as can occur in low-variety diet, or if weaning foods are introduce only in children older than 8 – 10 months. The socio-economic environment is often critical in the choice of the weaning food used.
- Other factors: Other factors such as the famines associated with climatic disaster or more often with political events and war (as has been the case in East Africa) can play a critical role in marasmus.
World Health Organization (2011) stated that the risk factors of marasmus are as follows.
- Chronic hunger
- Contaminated water supplies
- Inadequate food supplies
- Other vitamin deficiencies (vitamin A, E, or K)
- Poor unbalance diet lacking in grains, fruits and vegetables.
Signs and symptoms of marasmus
Symptom of marasmus can range from mild to severe depending on the degree of the malnutrition symptom may be experience daily or just once in a while . At times, any of these marasmus can be severe.
- Chronic or persisted diarrhoea.
- Fatigue
- Unexplained weight loss.
Severe symptom include,
- Fainting or change in level of consciousness.
- Full or partial paralysis of the leg.
- Loss of bladder or bowed control.
- Prolong vomiting or diarrhoea (WHO, 2011).
According Badaloo (2006), malnutrition is associated with marasmus leading to extensive tissue and muscle wasting as well as variable oedema, other symptoms includes dry skin, skin folds drastic loss of adipose tissue (body fact), voracious hunger and irritability.
Reducing the risk of marasmus
A nutrition well balance diet with lots of fresh fruits, vegetables, grains and protein helps reduce the risk of malnutrition and marasmus. The marasmus is related to an underlined disease, and then appropriate treatment of that disease should be done.
The risk of marasmus can also be reduce through
- Eating a nutrition, well balance diet.
- Discussing symptom with health care provider.
- Drinking proper sanitized water.
- Following recommended treatment course for infections, (Pubmed, Health, 2011).
Treatment of marasmus
It is necessary to treat not only cause, but also the complication of marasmus, including infections, dehydration and circulation disorders, which are frequently lethal lead to high mortality if ignored (Appleton and Vanbergen, 2013).
According to WHO (2011), treatment of marasmus involves a special feeding and rehydration plan and close medical observation to prevent and manage complication. Intravenous fluids and rehydration solution and nasogastic feeding tubes are form of treatment that may be used.
Complication of marasmus
Complication of untreated marasmus can be serious and may include,
- Growth problem in children.
- Joint deformity and destruction.
- Loss of strength.
- Loss of vision and dysfunction.
- Unconsciousness and coma (Pumbed Health 2011).
Other are
- Vitamin A deficiency.
- Lactose intolerance.
- Severe and symptomatic anaemia.
Nutritional management of severe marasmus
This period correspond to maintenance of vital function and tissue renewal. During this period, the electrolyte imbalanced, Infections, Hyperglycemia and hypothermia are treated and then feeding is started. Oral renutrition of a child should be started as early as possible, as soon as the child is stable and the hydro electrolyte, imbalance are corrected.
The overall good of nutritional management is to overcome anorexia often associated with marasmus, as well as to avoid the causes that lead to anorexia. The goal is usually to provide 80 – 100 Kcal /Kg /d in 12 meals per day or continuously to avoid Hyperglycemia (Schwaz, 2001).
The WHO recommends the user of liquid products, such as the F75 solution, which provide 75 Kcal /100ml, mainly as carbohydrates. This F75 solution is available as a ready to use formula or can be prepared using widely available food listed below.
Table preparation of F75 and F100 diets
| Ingredient | Amount in F75 | Amount in F100 |
| Dry skimmed milk | 25g | 80g |
| Sugar | 70g | 50g |
| Cereal flour | 35g | – |
| Vegetable oil | 27g | 60g |
| Mineral mix | 20 ml | 20 ml |
| Vitamin mix | 140 mg | 140 mg |
| Water to mix | 1000 ml | 1000 ml |
Source: WHO (2007)
Conclusion and recommendations
Having known that marasmus is a worldwide serious protein – energy malnutrition that involves 50 million children younger than 5 years. It is important to know that untreated marasmus could lead to growth problem in children, loss of strength, loss of vision, coma and even death.
Based on the above, it is recommended that,
- Children should be adequate fed nutrition’s and well balance diets.
- Infections known to be associated with marasmus should be well treated.
- Weaning should be done when the child is due and exclusive breastfeeding should be practice by the mothers.
- Governmental and non Governmental organization should provide food for those in war town areas.
- Adequate wholesome and food supplies should be made available to the population.
References
American Heritage Dictionary (2009). Fourth Edition. Washington. Houghton Mifflin Company.
Apple, H. & Vanbergen, M. (2013). Metabolism and Nutrition, Medicine Crash Course (4th ed). London. Inosby, pp. 130
Bada 100, A.V. (2006). Lipid Kinetic Differences between Children with Kwashiokor and those with Marasmas. . Am. J. Clin. Nutri. 83(6): 1283-8.
Joosten, K. F. & Hulst, J. M. (2008). Prevalence of Malnutrition in Rediatics Hospital Patients. Curr. Opin. Pediator 20(5). 590-6.
Pawellek, I.; Dokoupi, K & Kolitzko, B. (2008). Prevalence of Malnutrition in Pediatric Hospital Patient. Clin. Nutr. 27 (1): 72-6
Pubmed Health (2011). Malnutrition. Accessed May 24, 2011 from http://www.ncbi-nim.nih.mih..gov/pubmed_health/pm.H0001441.
Schwarz, S.M. (2001). Diagnosis and Treatment of Feeding Disorder in Children with developmental Disabilities. Pediatrics 108 (3) 671-6
Webster’s College Dictionary (2009). Marasmus. London: Random House Publishers.
WHO (2007). Community-Based Management of Severe and Acute Malnutrition: Geneva: WHO.
WHO (2011) Water Sanitation and Health (WSH): Water- Related Diseases. Geneva: WHO.
World Health Organisation (WHO) (2002). Mortality and Burden. Estimates for WHO Member State in 2002: Geneva: WHO.
