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October 2007 |
What is malnutrition?
Malnutrition is often lost in discussions around the subject of hunger, especially
in the context of the discourse to "end world hunger," or to "feed the world." These
blurred definitions help perpetuate the inadequate response to malnutrition.
It is crucial to distinguish between malnutrition and hunger, as malnutrition
requires responses that go beyond food aid.
Hunger is usually taken to mean a deficiency in caloric intake — any
person whose daily diet gives fewer than the defined minimum of 2,100
kcal is considered suffering from hunger, or undernourished. The typical
response to hunger is food aid that supplements a person's daily caloric
intake.
Malnutrition however is not merely the result of too little food. It
is a pathology caused principally by a lack of essential nutrients. Most
food aid is an inadequate response to malnutrition as it either delivers
insufficient amounts of essential nutrients or delivers them in a way
that they are destroyed by cooking or not taken up properly by the body.
Malnutrition is associated with half of all deaths in children under
the age of five each year. The risk of death is particularly high for
children with severe acute malnutrition, up to 20 times higher than a
healthy child.
Who is most at risk?
Malnutrition affects first and foremost children under the age of two,
but young children less than five years of age, adolescents, pregnant
or lactating mothers, the elderly and the chronically ill (including
those with HIV/AIDS and TB) are also vulnerable. Children are especially
susceptible to growth failure when foods have to be introduced to complement
breastfeeding in the first and second years of life. Wasting and other
forms of acute malnutrition often appear among children in seasonal
cycles, especially during the "hunger gap" period between harvests.
"When children suffer from acute malnutrition, their immune systems
are so impaired that the risks of mortality are greatly increased. A
banal children's disease such as a respiratory infection or gastro-enteritis
can very quickly led to complications in a malnourished child and the
risks of death are high ", says Dr. Susan Shepherd, MSF Medical Coordinator
for the nutritional program in Maradi, Niger.
In developing countries 146 million children under the age of five are
underweight, as defined by weight for age (one in four children). Sixty
million children under the age of five are wasted (almost one in ten
children).
South Asia, the Sahel and the Horn of Africa are the most alarming hotspots
for child malnutrition and mortality. Half of the deaths in children
under five in developing countries occur in these regions.
How is malnutrition identified?
Malnutrition is defined in three ways: by a weight for height indicator
with a reference population, or mid-upper arm circumference (MUAC),
or by the presence of edema (a bloated appearance to the feet and face).
If dietary deficiencies are persistent, children will stop growing and
become stunted (low height for one's age). This is referred to as chronic
malnutrition. If they experience weight loss or "wasting" (low weight
for one's height), they are described as suffering from acute malnutrition.
Both of these presentations of malnutrition may be further classified
as moderate or severe.
Severe acute malnutrition includes two main clinical forms - severe
wasting (called marasmus) and nutritional oedema (known as kwashiorkor).
It is the clinical analysis that determines if treatment will be in hospital
or with therapeutic RUF at home. MSF experience in Niger has been that
most children do not have complications and can therefore follow therapeutic
RUF treatment at home. Severe acute malnutrition has a case fatality
rate of up to 21% without effective intervention. But any child with
malnutrition is at an increased risk of developing complications leading
to severe illness and death.
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