Malnutrition is associated with almost half of all deaths in children under five each year. A lack of food or essential nutrients causes malnutrition: children’s growth falters and their susceptibility to common diseases increases. The critical age for malnutrition is from six months – when mothers generally start supplementing breast milk – to 24 months. However, children under five, adolescents, pregnant or breastfeeding women, the elderly and the chronically ill are also vulnerable.
Malnutrition is measured in three ways: weight-for-height, mid-upper arm circumference (MUAC), or by the presence of oedema (a bloated appearance to feet and face). MSF teams use a MUAC band to identify whether the child is suffering from acute malnutrition or is close to suffering from it.
Some children need intense care when they are initially diagnosed, especially if they are very weak and unable to take in solid food or fluids. Once they are stabilised, many children, if there are no complications, can use ready-to-use therapeutic food (RUTF) treatment at home. MSF uses RUTF to treat malnutrition throughout the globe. RUTF contains fortified milk powder and delivers all the nutrients that a malnourished child needs to reverse deficiencies and gain weight. With a long shelf-life and requiring no preparation, these nutritional products can be used in all kinds of settings, unless they are suffering severe complications. RUTF has revolutionised the treatment of severe malnutrition - providing foods that ensure rapid weight gain and are safe to use at home instead of children needing hospitalisation - so far more at-risk children can be reached.
In situations where malnutrition is likely to become severe, MSF takes a preventive approach, distributing nutritional supplements to at-risk children to prevent their condition from deteriorating further.
The risk of death is particularly high for those with severe acute malnutrition, up to 20 times higher than for a healthy child.
Severe acute malnutrition in early childhood is common in large areas of the Horn of Africa, the Sahel and South Asia — the world’s “malnutrition hotspots” where people often can’t access highly nutritious foods like milk, meats and fish.
Malnutrition is not the same as hunger
Hunger is a deficiency in caloric intake - anyone whose daily diet gives fewer than the defined minimum of 2,100 kcal is considered suffering from hunger, or undernourishment. Malnutrition is a pathology caused mainly by insufficient essential nutrients, not merely because of too little food.
When children experience weight loss or 'wasting' (low weight for one's height), they are described as suffering from acute malnutrition. Chronic malnutrition occurs when dietary deficiencies are persistent, causing children to stop growing and become stunted (low height for one's age). Both of these presentations of malnutrition may be further classified as moderate or severe.
Severe acute malnutrition occurs when reserves of fat and muscle disappear because of inadequate supplies of energy and micronutrients. Severe acute malnutrition has a case fatality rate of up to 21% without effective intervention.
MSF admitted 181,600 malnourished children to inpatient or outpatient feeding programmes in 2015.
What causes malnutrition?
Breast milk is the only food a child needs for its first six months. Beyond this point breastfeeding alone is not sufficient.
Diets at this stage must provide the right blend of high-quality protein, essential fats and carbohydrates, vitamins and minerals.
In the Sahel, the Horn of Africa and parts of South Asia, highly nutritious foods such as milk, meats and fish are severely lacking.
For a child under the age of two, their diet will have a profound impact on their physical and mental development.
Malnourished children under the age of five have severely weakened immune systems and are less resistant to common childhood diseases.
This is why a common cold or a bout of diarrohea can kill a malnourished child. Of the eight million deaths of children under five-years-of-age each year, malnutrition contributes to at least one-third.
Symptoms of malnutrition
Understandably, the most common sign of malnutrition is weight loss. Loss of weight may also be accompanied by a lack of strength and energy and the inability to undertake routine tasks. Those who are malnourished often develop anaemia and therefore a lack of energy and breathlessness.
In children, signs of malnutrition may include an inability to concentrate or increased irritability and stunted growth.
In cases of severe acute malnutrition, swelling of the stomach, face and legs and changes in skin pigmentation may also occur.
Malnutrition is diagnosed by comparing standard weights and heights within a given population, or by the measurement of a child’s mid-upper arm circumference (MUAC).
If dietary deficiencies are persistent, children will stop growing and become ‘stunted’ – meaning they have a low height for their age. This is diagnosed as chronic malnutrition.
If they experience weight loss or ‘wasting’ – low weight for one’s height – they are diagnosed as suffering from acute malnutrition.
This occurs when a malnourished person begins to consume his or her own body tissues to obtain needed nutrients.
In the severe acute form, children with kwashiorkor – distended stomachs – can be clinically diagnosed with body swelling irritability and changes in skin pigmentation.
We believe that ready-to-use therapeutic food (RUTF) is the most effective way to treat malnutrition. RUTFs include all the nutrients a child needs during its development and helps reverse deficiencies and gain weight.
RUTFs don’t require water for preparation, which eliminates the risk of contamination with water-borne diseases.
Because of its packaging, RUTFs can be used in all kinds of settings and can be stored for long periods of time. Unless the patient suffers from severe complications, RUTFs also allow patients to be treated at home.
Where malnutrition is likely to become severe, we take a preventative approach by distributing supplementary RUTF to at-risk children.