Introduction
Globally, the health of children has been of great importance in any nation, the child in many homes is the source of joy and when the health of the child is at risk, it calls for so many reasons for instability in the home. Most African homes also do not take some certain disease conditions serious in the child and one of these is malnutrition which has been termed “the silent emergency” by Edukugho (2004). Malnutrition results from food insufficiency as well as poor social and economic conditions. Malnutrition has been identified as a big problem affecting developing countries especially school children from poor homes. He further stated that majority of school children lack the food they need thereby resulting in malnutrition, now posing a serious threat to education, particularly in developing countries including Nigeria.
This condition affects over one third of children globally and it is a major concern to all nations to fight the disease condition. Therefore step must be taken to educate mothers who are expecting another new baby as these children suffer a lot of nutritional deficiencies. In the African context, they believe that the pregnancy is what affects the child and makes the child sick.
According to Steven (2003), malnutrition is the insufficient, excessive or imbalanced consumption of nutrients. A number of different disorders may arise depending on which nutrients are under or over abundant in the diet. Behrman (1996), malnutrition is a term used to describe the condition caused by a diet that contains all the essential nutrients but in suboptimal amounts. It is compatible with life and the same metabolic changes occur as in starvation but to a lesser degree.
Benton and Sergeant (1992) see malnutrition as a result of prolonged nutritional defects e.g. proteins, minerals, vitamins or calories. Malnutrition is a disorder concerning nutrition. It may result from a poor diet or from impaired utilization of foods ingested (Mosby’s Dental Dictionary, 2008).
Conceptual framework
Malnutrition is a term that is used to classify nutritional status which is characterized by inefficient intake of protein and energy. According to Wardlaw (2003), malnutrition is a condition resulting from regularly consuming of insufficient amount of energy and protein. The deficiency eventually results in body wasting primarily of lean tissues and an increased susceptibility to infection. Malnutrition therefore can be referred to as inadequate availability of energy and protein in the body. Since the major dietary requirement of the body is protein and energy. It is the major form of malnutrition worldwide as over a third of the world’s children population suffers some degree of this type of malnutrition (Wardlaw, 2003).
These conditions have become very serious problem in our communities but parents of children that suffer from this problem do not take it as a life threatening condition. They perceive it as a result of some other causes like spiritual causes and also they feel it is a normal problem that occurs in children which they will outgrow later in life.
Causes of malnutrition
The causes range from the individual to the family and then to the society. There are factors that are responsible for the manifestation of malnutrition in a child within the immediate family, the child and the community in which the child lives. Obviously, Seear (2000) states that the primary cause of Malnutrition is poor nutritional intake, but there are many underlying social and family problems contributing to the cause of the condition.
Underlying causes of malnutrition
According to Seear (2000), there are other factors around and within the environment of the child that contributes to the development of Malnutrition in a child. They are;
- Family background and education: Traditional customs based on a stable, extended family cannot meet the demands of life in an informal pen-urban settlement with the needs for both parents to work or the loss of the father due to migrant labour, war or social unrest. The belief of rural dwellers on how food should be given to young children contributes greatly to the disease condition. In places where protein giving diets such as meat, fish, eggs are restricted from the child with the belief that the child would steal later in life predisposes the child to become malnourished. Lack of education of mothers lead to plenty of ignorance on their own part in respect to not knowing what quantity and quality of food needed by the growing child.
- Socio-economic status of the family and community: Most rural dwellers are low income earners category who cannot feed their families properly, even when the child or any member of the family falls sick, good medical care cannot be provided. War, earthquake and other natural disasters like famine increase the rate of malnutrition in developing world.
According to Park (2005) “there are numerous other contributing factors in the web of causation viz; poor environmental condition, large family size, poor maternal health, failure of lactation, premature termination of breast feeding and adverse cultural practices relating to child rearing and weaning such as the use of over diluted cow’s milk and discarding cooking water from cereals and delayed supplementary feeding.
Types of malnutrition
There are so many clinical types of malnutrition but emphasis will be laid on the most common types which are; kwashiorkor and marasmus.
- Kwashiorkor
Seear (2000) says that kwashiorkor in the Ghanaian language is divided into “kwashi” a name given to a male child born on a Sunday while “korkor” is a light red colour presumably reflecting the changes in the skin and hair found in these children. It is the most severe, fatal characteristics form of malnutrition. It occurs most frequently after weaning or when complementary diets are introduced to the child’s feeding, regimen, usually between 9 months and 2 years of age.
According to Lankinen (2002), there is marked oedema, which may give the child a chubby appearance in the face.
- There is large muscle loss which is part of the reason for the inactivity of these children who are frequently unable to walk or at times to sit and hold their heads up.
- The skin changes are pathegroid in type with increased pigmentation and desquamation.
- The mouth also shows reddening with atrophy of the tongue, papillae and a fissuring at the corner of the mouth.
- The hair is sparse thin and easily pulled out and may change to reddish colour.
- Following measles, the rash of kwashiorkor may cover the whole body and difficulty arises in deciding how much the rash is due to measles and how much to kwashiorkor.
- There are mental and neurological changes. Apathy and irritability are always present and the child is always unhappy.
- The hair is palpable and firm. There is frequent anaemia associated with iron, folic acid and protein deficiency.
- There is depressed immunity, which makes underlying infections worse.
Marasmus
According to Wardlaw (2003), the word marasmus means to waste away in Greek. Victims have a skin and bones “appearance with little or no subcutaneous fat”. Marasmus results from diets containing insufficient amount of proteins, energy and other nutrients.
Wardlaw (2003) also stated that “marasmus” commonly develop in infants who either are not breast fed or have stopped breast feeding in the early months. Often, a weaning formula used is improperly prepared because of unsafe water and because parents cannot afford sufficient formula for the child’s needs. This may lead the parents to dilute the formula to provide more feeding not realizing that this provides only more water for the infant. It occurs mostly in cities of poverty stricken countries where bottle feeding is necessary as those infants are left under the care of relatives or others where mother is working.
Seear (2000) gave the clinical characteristics of marasmic children as follows;
- They are usually irritable but alert and will feed eagerly if food is offered.
- They have marked decreased subcutaneous tissues and muscles mass.
- They frequently have diarrhoea with abdominal distension.
Nutrition: Its influence on growth and development
The growth and development of children is very important in every society. As it is popularly said, “the children of today are the leaders of tomorrow” and if they do not develop well, it will affect the quality of leaders that will be produced in future.
Campbell and Glasper (1999) stated that “the single most important influence on growth is nutrition. Dietary factors regulate growth at all stages of development and their effects are exerted in numerous and complex ways”. This is to say that the quality and quantity of food that is given to the child determines the growth and developmental patterns in the child. A child who gets the necessary dietary requirements from conception through birth and the preceding years of early life grows and develops healthy.
During the rapid pre-natal growth period, any fault in the nutritional status of the mother will influence the development of the foetus. According to Campbell and Glasper (1999), severe maternal malnutrition during the period of most rapid brain growth is associated with permanent reduction in the total number of foetal brain cells and have a critical effect on the child’s intellectual functioning.
Wardlaw (2003) stated that “the majority of brain growth occurs between conception and the child’s first birthday. In fact, the brain is growing at its highest rate at birth. If the diet does not support brain growth during the first months of life, the brain may not grow well. This reduced brain growth may lead to diminished intellectual functioning”. The demand for protein and calorie during infancy and childhood is evidenced by the rapid increase in height and weight as these nutritional requirements are needed in higher amount than when the child was in the uterus and in the early months of life because the child’s metabolic rate is higher due to increase in activity. Edukugho (2004) puts it that “malnutrition causes poor growth in children leading to impaired mental development, poor scholastic and intellectual development.
In the growing child, inadequate nutrition is dangerous. Children who are not well fed always fall sick as their immune system is lowered. Time for these children to be in school and learn is often used to either stay at home as sick children or are in the hospital beds. This reduces their chances of learning at school. The growth and development of children must be put into consideration. Children must develop well during their early life so that every aspect of their health is built up to avoid growth and developmental problems and health problems such as them having a low immune response to diseases.
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
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Benton, D. & Sargent, J. (1992). Breakfast, Blood Glucose and Memory. Biol Psychol, 33 (2-3): 207—10.
Campbell, K. & Glasper, M. (1999). Whaley and Wong’s Children Nursing. London: Gnselda Campbell.
Edukugho, E. (2004). Malnutrition on a Silent rampage in Schools in Nigeria. Vanguard Newspaper
Lankinen, E. T. (2002). Health and Disease on Developing Countries. Malaysia: Macmillian Education.
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Park, K. (2005): Textbook of Preventive and Social Medicine. 18th edition, Jabalpur (India): M/S Banarsidas Bhanot.
Seear, M. (2000). A Manual of Tropical Paediatrics. United Kingdom: Cambridge University Press.
Steven, M. S. (2003). Economics: Principles in Action. Upper Saddle River, New Jersey: Pearson Prentice Hall. pp. 481
Wardlaw, G. M. (2003). Contemporary Nutrition: Issues and Insight. (5th ed.). New York: McGraw Hill.
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