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Malnutrition in Children

Approximately, one out of every three children under five in developing countries is malnourished. Data clearly shows that the worst affected region is South Asia. 50 percent of children in the whole of South Asia are not able to meet their food requirements and are therefore undernourished (Gulati 2010). Across Africa, Severe Acute Malnutrition (SAM) affects approximately 3% of children under five at any time and is associated with several hundred thousand child deaths each year (Briend and Collins 2010).

Malnutrition is simply defined as imperfect or faulty nutrition. Whenever there was an imbalance between body needs for certain nutrient and their intake, malnutrition could said to have occurred. It could be of two types: undernutrition - a condition where the body requirements for nutrients are not met, overnutrition when these are oversupplied. But malnutrition and undernutrition are generally used synonymously because a vast majority of the people are undernourished than over-nourished (Gulati 2010).

Children and women appear to be the most sufferers. The signs and symptoms are lethargyphysical and mental, low weight in relation to height and age, diminished skin folds, exaggerated skeletal contours and loss of elasticity of skin (Sharma 1977; Gulati 2010).

A study conducted by Haroon Saloojee, Tim De Maayer, Michel L. Garenne, and Kathleen Kahn in South Africa has identified a number of alternative ways that severe malnutrition can be tackled in predominantly poor, rural community. Diverse risk factors such as poor household food security, unhealthy feeding practices, suboptimal access to quality health services, disruptions of family structure (influenced by the effects of HIV), and inadequate access to child support grants all contributed to the problem and lend themselves to potential interventions. None is mutually exclusive, and the need to focus on multiple interventions, including economic, educational, health, and social welfare services, in the prevention and management of severe malnutrition is made overt (Saloojee, et al 2007).

Two independent determinants, nevertheless, predominated. First, the role of suboptimal feeding (particularly breastfeeding and weaning) practices and poor nutrient intake (low food diversity or lack of food associated with poverty), even after

and these minerals were added to the diet. sick. and sugar. The relationship between malnutrition and mortality is complex. Second. difficult to study and not fully understood. or dead) influence (Saloojee. At that time. diluted into clean water. including income. an innovation progressively introduced a radically new approach. (ii) handing over the identification of SAM to the community through the use of MUAC. and then treated with a mixture of dried skimmed milk. Three key innovations underpinned this revolution in care: (i) the introduction of technique to engage with communities to promote early presentation and compliance(Damme and Boelaert 2002). One problem is that most cause-specific mortality statistics usually do not indicate nutritional deficiencies as a cause of death. was the role of HIV. et al 1974). oil. either as a direct (infected child) or indirect (parents infected. The result was that people presented for treatment early and in large numbers. et al 2007). and of equal importance. Other minerals and vitamins were given directly (Briend and Collins 2010). In the mid-90s. understandable and affordable (in terms of opportunity costs to poor people). it was already acknowledged that SAM children needed additional potassium and magnesium. infections. Children were then admitted to large inpatient feeding centres based on their arm circumference for height or for age. It is difficult to quantify the contribution of protein-energy malnutrition to the high rates of death in early childhood in deprived areas. at a time when their condition was still easily treatable at home (Briend and Collins 2010). The initial efforts to treat large numbers of children with severe acute malnutrition (SAM) emerged during the Ethiopia famine of the mid-70s (Mason. The move to the community-based treatment of SAM has made it possible to address SAM as a public health problem treating millions of children across 35 . The overall effect of these changes was to make treatment accessible. especially diarrhea and acute respiratory infections are mostly mentioned as primary causes. and (iii) the development of Ready to Use Therapeutic Foods (RUTF). There are severe diagnostic problems both with anthropometry and with 'verbal autopsies' and it is difficult to discern primary and contributory causes of death. moving the treatment of SAM from inpatient hospitals and feeding centres into the community. In mortality statistics.controlling for many other potentially confounding factors. Infections and malnutrition may increase each other's severity but have also properties that may lead independently to a fatal outcome (Van den Broeck 1995). was paramount.

The result is huge improvements in program coverage and greatly reduced mortality rates. that previously limited both the numbers of children treated and the quality of treatment for those that did manage to gain access. delivers a cost effectiveness comparable to mainstream public health interventions such as vitamin A distribution (Bachmann 2009). . Community-based management using RUTF has reduced costs and.countries in the past few years. The local production of RUTF using local crops grown by small holder farmers affords a mechanism to link nutritional treatment with improvements in agricultural incomes that. if targeted correctly. could be a valuable tool to improve food security in selected vulnerable populations (Briend and Collins 2010). in terms of the cost per disability adjusted life year (DALY) gained. This change has addressed key capacity constraints especially those of trained staff and hospital inpatient capacity.