General

causes and effects of malnutrition among children under five years

Introduction

Malnutrition is the condition that result from taking an unbalanced diet in which certain nutrient are lacking in excess (too high of an intake) or in the wrong proportions. A number of different nutrition disorders may arise depending on which nutrients are under or over abundant in the diet (Arthur & Steven, 2008).

The World Health Organization (WHO) (2006) defines malnutrition as the cellular unbalance between supply of nutrients and energy and the body’s demand for them to ensure growth, maintenance and specific functions. Women and young children are the most adversely affected groups one quarter to one half of women of child bearing age in Africa and south Asia are under weight, which contributes to the number of low birth weight infants born annually.

Malnutrition is globally the important risk factor for illness and death, contributing to more than half of death in children worldwide, child malnutrition was associated with 54% of death in children in developing countries in 2001. The WHO (2006) estimates that by the year 2015, the prevalence of malnutrition will decreased to 17.6% globally with 113.4 million children younger than 5 years affected as measured by low weight for age. The overwhelming majority of children 112.8 million will live in developing countries which 70% of these children in Asia, particularly the south central region and 26% in Africa.

According to the WHO (2006), malnutrition has three commonly used comprehensive names shirting, wasting and underweight measures by height for age, weight for height, and weight for age. Stunting or growth retardation or chronic portion-energy malnutrition (PEM) is deficiency for calories and protein available to the body tissue and it is inadequate intake of food over a long period of time or persistent and recurrent ill-health. This height for age (stunting) is less sensitive to temporary food shortages, should be considered as the most reliable indicator (Kristof & Nicholas 2009).

Wasting or protein energy malnutrition during the period immediately before the survey resulting from recent episodes of illness and diarrhoea; In particular or from acute food storage protein, Energy malnutrition (PEM) described in the 1920’s observed most frequently in developing countries but has been described with increasing frequency in hospitalized and chronically ill. Kwashiorkor and marasmus are two form of (PEM). Marasmus involves inadequate intake of protein and calorie. Kwashiorkor has fair to nominal calorie intake with inadequate protein intake.

Overview on malnutrition

Pauline and Bralim (2009) stated that severe protein energy malnutrition show itself clinically as marasmus, kwashiorkor and marasmic kwashiorkor. A marasmic child is emaciated, irritable and unless there is complication, there is good appetite while in kwashiorkor there is oedema, apathy irritability and poor appetite, the skin and hair become lighter in colour.

There is also cracking ulceration of the skin flaky palm and detmatosis may follow if not treated. He went further to say that marasmic kwashiorkor manifest both sign and that the essential cause of the condition is not vitamin deficiency, not folic acid deficiency although these may also be present but lack of food and precipitating illness to malnutrition. Grodon and Paul (2009) explained that protein energy malnutrition is a form of under-nutrition caused by an extremity or accompany illness. The typically dramatic result of protein-energy malnutrition is kwashiorkor and marasmus. Grodon (2003) viewed malnutrition and its failing health as a result of long standing dietary practice that do not coincide with nutritional needs.

The condition is also commonly referred to as protein energy malnutrition especially when experienced by older children and adult. Robbin and Contran (2004) stated that in the third world countries, under nutrition continue to be common and in the industrialized societies the most frequent disease like arthrosclerosis, cancer, diabetes and hypertension have all been linked to some form of dietary impropriety. Severe protein energy malnutrition is a disastrous disease; it is common in the third world countries where up at 27% of children may be affected. In these countries the major factor causing high death rate among children younger than five years of age is malnutrition. He further said that the cause of malnutrition are ignorance, chronic, alcoholism, acute or chronic illness, self impose diet, mal-absorption syndrome and genetic diseases.

Ross and Wilson (2006) pointed that protein energy malnutrition is as a result of inadequate intake of protein, carbohydrate and fat. And that it occurs during the period of starvation and when dietary intake is inadequate to meet increased requirement e.g. fever, trauma and illness. He also said that infant and young children are especially susceptible as they need sufficient for grow and develop normally. If dietary intake is inadequate, it is common for vitamin deficiency to develop at the same time.

The degree of malnutrition can be assessed from measurement of body mass index (BMI), malnutrition can be prevented by eating a good balance diet. He went further to say that poor nutrition (malnutrition) reduces the ability to combat other illness and infection. Lavender (2007) said that protein energy malnutrition is a deficiency syndrome caused by inadequate intake of macro-nutrients protein energy malnutrition or protein caloric malnutrition is not characterized by only an energy deficit due to a reduction in all macro-nutrient but also a deficit in many micro-nutrients.

Victoria (2007) pointed out that children in the third world countries can fail ill from nutritional disease such as marasmus and kwashiorkor. She said that in 1991, children between the age of two month and five years was presented at hospital or Lesotho with varying degree of marasmus and kwashiorkor with the lather carrying highest mortality rate in children. Marasmus and kwashiorkor are deficiency resulting from lack of protein or energy given food.

Definition of malnutrition

Klein (2007) defined malnutrition as a condition that develop when the body does not get the proper amount of protein energy (calorie), vitamin and other nutrient it need to maintain healthy tissue and organs. Gordon (2003) said that malnutrition and its failing health is defined as a long standing dietary practice that does not coincide with nutritional need.

Ross and Wilson (2006) defined malnutrition as inadequate intake of protein, carbohydrate and fat. It occurs during the period of starvation and when dietary intake inadequate to meet increase requirement of the body e.g. in case like fever, trauma and illness. Lavender (2007) stated that malnutrition is defined as a deficiency syndrome caused by inadequate intake of macro-nutrient. Klein (2007) defined malnutrition as a condition that develop when the body does not get the proper amount of protein energy (calorie), vitamin and other nutrient it need to maintain healthy tissue and organs.

Types of malnutrition

Pauline and Ebralin (2009) stated that protein malnutrition (PEM) shows itself clinically as marasmus, kwashiorkor and marasmic kwashiorkor.

Marasmus: Is caused as a result of calorie deficiency. A child marasmus look emaciated, there is good appetite

Kwashiorkor: Is a form of malnutrition due to protein deficiency. Children are usually underweight has poor appetite, the skin and hair become lighter in colour, cracking and ulceration of the skin, flaky palm, dermatosis may follow if not treated. Marasmic kwashiorkor is a mixed form of malnutrition in kwashiorkor and marasmic (lack of protein and calorie) because it manifests both signs.

According to Robbins and Contra (2004) stated that malnutrition present in many form e.g. marasmus and kwashiorkor. Marasmus is referred to malnutrition caused by primarily by several reductions in calorie intake. He said that kwashiorkor is a form of severe energy malnutrition due to protein deficiency.

Ross and Wilson (2010) stated that malnutrition is in two form e.g. marasmus and kwashiorkor. Kwashiorkor is caused by protein deficiency while marasmus is caused by deficiency of both protein and carbohydrate.

Causes of malnutrition

According to Pauline and Ebrahim (2009) point out that the essential causes of the condition is not vitamin deficiency, not folic acid deficiency although those may be also present but lack of food and precipitating illness like diarrheal, measles or pertusis can lead malnutrition.

Robbins and Contra (2006) said that most causes of malnutrition are ignorance, chronic alcoholism, acute or chronic illness, self imposed diet, mal-absorption syndrome and genetic diseases. Klein (2007) said that there are numbers of causes of malnutrition, it may result from inadequate unbalance diet, problem with digestive or absorption, certain medical condition. Malnutrition can occur if you do not eat enough food, you may develop malnutrition if you lack single vitamin in a diet. Other cause include poverty, natural disaster, political problem and war also contribute to this condition.

Effects of malnutrition

According to Dorling (2002) he stated that the effects of malnutrition are mental handicap and unpaired growth which is usually seen in a child with marasmus. He further stated that if a child less than two years suffers from kwashiorkor, it will lead to permanent stunted growth. Klein (2007) stated that if malnutrition is not treated it can lead to mental or physical disability, illness and possible death may occur.

Signs and symptoms of malnutrition

Pauline and Ebrahim (2009) pointed that the symptoms of malnutrition varied a marasmic child look little old, no fat, hung, gross muscle wasting, gross under weight, growth retardation but hair is normal. While kwashiorkor there is oedema, loss of appetite, loss of weight, hair change in colour and the child look anaemic (shortage of blood).

Dorling (2002) stated that the signs and symptoms of malnutrition differs, a child with kwashiorkor has studded growth, there is puffy appearance due to oedema, the liver is enlarge, dehydration may develop, the child losses resistance to infection. In advance case, there is jaundice, drowsiness and reduced temperature while in marasmus there is emaciation, stunted growth, loss of fold skin on the limbs and buttocks. Klein (2007) stated that the symptoms of malnutrition vary and depends on what is causing it. However, some general symptoms include fatigue, dizziness and weight loss.

Prevention of malnutrition

In preventing malnutrition, different types of action/preventive measures must be taken both on the mother and the child. The expectant mother must be given adequate information on good diet both for herself and the child from when the child is born till his adolescent age.

Park (2005) states the 8th Food and Agriculture Organisation/ World Health Organisation experts committee on nutrition for the prevention of malnutrition in the community as follows;

Health promotion

Measures directed to pregnant women (education, distribution of supplements).
Promotion of breast feeding.
Development of low cost weaning foods i.e. the child should be made to eat more food at frequent intervals.
Nutrition education i.e. promotion of correct feeding practices.
Home economics
Measures to improve family diet
Family planning and spacing of births
Family environment
Campaign should be on television and radio to sensitize parents.

Specific protection

The child’s diet must contain protein and energy – rich foods like milk, eggs, fresh fruits should be given if possible.
Immunization
Food fortification

Early diagnosis and treatment

Early diagnosis and treatment of infections and diarrhoea.
Early diagnosis of any lag in growth.
Development of programmes for early dehydration of children with diarrhoea.
Development of supplementary feeding programmes during epidemics.
De-worming of heavily infested children.

Rehabilitation

Nutritional rehabilitation services
Hospital treatment
Follow up care

It is also important to note here that malnutrition is a common problem in poor countries/communities so government should improve on the socio-economic status of their people. The health workers also have the responsibility of evaluating the nutritional status of the population they are serving and ensure that all children grow regularly and adequately.

Lankinen (2002) for children to grow regularly, some system of monitoring is essential and in an attempt to make this possible, growth charts have been widely recommended by the international organizations such as WHO, UNICEF and Save the Children Fund.

References

Arthur, S. & Steven, S. (2003). Economics Principles of Action. Upper Saddle Rivers. Edgar & Keith Co.

Dorling, K. (2002). Illustrated Medical Dictionary. (2^nd ed.), UK: Macmillan Education.

Gordon. M. (2003): Contemporary Nutrition, (5^th ed.), New York: McGrawhill Companies.

Gordon, S.K & Paul J.I. (2009). Failure to thrive. (7^th ed.) London: Indigo Press.

Kelein, S. (2007). Protein Energy Malnutrition (23^rd ed.), London: Goldman Limited.

Lavender, G. (2007). Pediatric Care. (8^th ed.), Dublin: Jenson Press.

Pauline, D. & Ebralium, G.T. (2009): Practical Care of Sick Children. London: Macmillan Education.

Robbins, D.U & Coutran, Y.A. (2004): Pathological passes of Disease, (7^th ed.), Beijing: Kumar Viany.

Ross, N.T. & Wilson, W.T. (2006). Anatomy and Physiology in Health and illness, (10^th ed.), Glasgow: Elsevier

Shafigure, S., Akhter, N., Staikamp, G., DcPee, S., Agides, D. & Beloem, M.W. (2007): Effect of Malnutrition on Children. New York: Sage Publication.

World Health Organization (WHO), (2011): Water Related Disease. Geneva: WHO.