MALNUTRITION

• Malnutrition is one of the most important health

and welfare problems in Zambia.
• It simply means bad feeding.
• It is as result of inadequate food intake and
illness (imbalanced nutrient and/ or energy
intake)
• Inadequate food intake is due to insufficient food
available at household level, improper feeding
practices or both.
• Improper feeding practices include both
quality and quantity of food offered,
frequency of feeding and also timing on
introduction of other foods to the children.
• Poor sanitation puts anybody, especially young
children at risk of illness especially diarrhoeal
diseases, which adversly affect their
nutritional status
• Malnutrition leads to health and economic
consequences, the serious of which are
increased death.
• Severe malnutrition is one of the most
common cause of morbidity and mortality
among children under five years world wide.
(WHO training manual 1999)
• It also leads to increased risk of illness and lower
level of cognitive development, which results in
lower educational attainment.
• In adults there will eventually be a reduction in
work productivity and increased absenteeism in
work place.
• Malnutrition can result in adverse pregnancy
outcomes, which over generations may actually
change the stature of individuals and communities.
 TYPES OF MALNUTRITION
Chronic malnutrition
Acute malnutrition
Underweight
Stunting
Overweight
Protein Energy Malnutrition (PEM)
Vitamin A Deficiency (VAD)
Iron Deficiency Anaemia (IDA)
Iodine Deficiency Disorder (IDD)
 Chronic malnutrition
• Chronically malnourished individuals are too
short for their age.
 Acute malnutrition

• Manifested by wasting, being too thin for

the height, with weight for height Z-score
that is below -2SD based on the
NCHS/CDC/WHO reference population.
• Acute malnutrition is the result of recent
failure to receive adequate nutrition and may
be affected by acute illness, especially
diarrhoea, measles.
Severe, Moderate and Acute Malnutrition

Severe Acute Malnutrition(SAM):

Z-scores < -3 SD
Moderate Acute Malnutrition(MAM):
Z-score <-2>-3SD
Management of Severe, Moderate and Acute
Malnutrition (SAM, MAM)
• Outpatient Therapeutic program: for children
with SAM without complications.
Given Plumpy nut, basic anti-malarials,
antibiotics, micronutrients (vit A, folate),
diagonestic testing and counselling (DCT) done
• Inpatient Therapeutic program: Children with
SAM with complications are admitted, given
dextrose and put on F75 followed by F100 then
plumpynut. Medications are given as above.
• Food Supplementation Program: Families of
children with MAM are given assorted foods
such as cooking oil, mealie meal and beans to
suppliment family meals.
 Underweight

• Child has weight for age Z-score that is below

-2SD based on the NCHS/CDC/WHO reference
population.
• It is indicative of children who suffer from
chronic or acute malnutrition, or both, and may
be influenced by both short and long term
determinants of malnutrition.
• Underweight is often used as a general
indicator of status of a population’s health.
 Stunting
• Stunting is a good long-term indicator of
nutritional status of a population because it is
not markedly affected by short term factors
such as the season of data collection, epidemic
illnesses, acute food shortages, recent shifts in
social or economic policies.
• Inadequate sanitary facilities result in an
increased risk of diarrheal diseases which
contributes to malnutrition (stunting).
 Overweight
• Child has weight-for-height Z-score that is
above 1SD based on NCHS/CDC/WHO.
• The mother’s nutritional status affects her
ability to carry, deliver, and care for her
children successfully.
• Malnutrition in women can be assed using the
body mass index (BMI). BMI is defined as the
woman’s weight (kg) divided by the square of
her height in meters. Thus BMI = kg/m²
• BMI below the suggested cutoff point of 18.5
indicates chronic energy deficiency or under
nutrition for non pregnant, non lactating
women.
• BMI above 25, women are considered over
weight.
• Women less than 145 centimeters in height are
considered too short.
• Stunted girls during childhood and adolescence, in
adulthood may have difficulty during child birth
because of the small size of their pelvis.
• They also more likely to give birth to low birth weights.
• Underweight status in women is assessed using BMI.
• Pregnant women are not included in the malnutrition
analysis due to weight considerations.
Protein Energy Malnutrition (PEM)
• PEM is caused by the lack of protein, energy, or both.
• PEM affects populations around the world. It is responsible for
about half of 10.9 million child deaths per year.
• In young children PEM can cause permanent disabilities
because most brain growth occurs during the early years of life.
• Extreme PEM results in the conditions of Marasmus and
Kwashiokor.
• These disorders can be fatal because of decreased resitance to
infections; the body lacking protein is unable to create
sufficient quantities of antibodies to support the immune
system.
Marasmus
• Malnutrition caused by lack of sufficient
energy (kcal intake).
• An individual with marasmus is extremely
thin; skin seems to hang on the skeletal bones.

• Fat stores that normally fill out the skin have

been used for energy to maintain minimum
body functining.
• Muscle mass is reduced, having also been used for
energy, and nutrients are not available to rebuild it.
• If the condition continues, damage may occur to
major organs such as the heart, lungs and kidneys.
• Marasmic children will not grow.
• If the condition occurs between 6 to 18 months of
age, time during which the most brain development
occurs, permanent brain damage may result.
Kwashiokor
• Symptoms of Kwashiokor give the appearance
of more than sufficient fat stores in the stomach
and face.
• Kwashiokor is caused by lack of protein while
consuming adequate energy.
• The swollen belly and full cheeks of Kwashiokor
are caused by edema water retention)
• Edema occurs because protein levels in the
body are so low that protein is not available to
maintain adequate water balance in the cells,
fluid accumulates unevenly.
• When adequate nutrition is provided, the fluid
is no longer retained.
• Instead of a full belly and round cheeks, the loss
of fat stores becomes apparent and the skin
hangs loosely, similar to marasmus.
• An individual with kawshiorkor is apathetic and
experiences muscle weakness and poor growth.
• Without sufficient protein, lipids produced by the liver
are unable to leave and thus accumulate there. The
liver becomes fatty and unable to function well. Even
hair quality is affected because protein is the main
constituent of hair.
• Curly hair becomes straight, hair falls out easily, and
the pigmentation chnages.
• Skin develops a scaly dermatitis (rash).
 Vitamin A deficiency (VAD)
• Common in dry environments where fresh
fruits and vegetables are not readily available
• Found in breast milk
• Found in other milks, liver, eggs, fish, butter,
red palm oil, mangoes, papaya, carrots,
pumpkins, and dark leafy greens
• Consumption of oils or fats is necessary for its
absorption in the body
• The liver can store an adequate amount of
vitamin A for four to six months.
• Periodic dosing (every 4 to 6 months) with
vitamin A supplements is rapid, low cost
method of ensuring that children at risk do not
develop VAD. National immunisation days for
polio or measles vaccinations reach large
numbers of children with vitamin A
supplements well.
• Pregnant women who are vitamin A deficient
are at a greater risk of dying during or shortly
after delivery of a child.
• Pregnancy and lactation strain women’s
nutritional status and their vitamin A stores.
• For women who have just given birth, vitamin A
supplementation helps to bring their level of
vitamin A storage back to normal, aiding
recovery and avoiding illness.
• Vitamin A supplementation also benefits children who
are breastfed.
• If mothers have vitamin A deficiency, their children can
be born with low stores of vitamin A.
• Low birth weight babies are especially at risk.
• Additionally, infants often do not receive an adequate
amount of vitamin A from breast milk when mothers
are vitamin A deficient.
• Therefore supplementation is important for postpartum
women. Within the first 8 weeks after childbirth.
 Anaemia
• Anaemia is lack of adequate amount of
hemoglobin in the blood. It can be caused by
several different health conditions;
- iron, and folate deficiences
- V B12 deficiency
- Sickle cell disease
- Malaria
- Parasite infection
• Iron deficiency anaemia is most common form
of nutritional deficiency world wide.
• It develops slowly and does not manifest
symptoms until anaemia becomes severe.
• Diets that are heavily dependent on one grain
or starch as a major staple often lack sufficient
iron intake.
• Iron is found in meats, poultry, fish, grains,
some cereals, and dark leafy greens (such as
spinach).
• Foods rich in vitamin C increase absorption of
iron into the blood.
• Tea, coffee, whole-grain cereals can inhibit
iron absorption.
• Anaemia is common in children 6-24 months
of age who consume a purely milk diet and in
women during pregnancy and lactation.
• Iron deficiency anaemia is related to
decreased cognitive development in children,
decreased work capacity in adults, and limited
chances of child survival.
• Severe cases are associated with the low birth
weight of babies, perinatal mortality and
maternal mortality.
 Iodine deficiency
• It is known to cause goiter, cretinism (severe
form of neurological defect), spontaneous
abortion, premature birth, infertility, still birth,
increased child mortality.
• One of the most serious consequences of child
development is mental retardation caused by
iodine deficiency disorder (IDD), which puts at
risk social investments and health and
education.
• IDD is a single most common cause of preventable
mental retardation and brain damage in the world.
• It decreases the production of hormones vital to
growth and development.
• Children with IDD can grow up stunted, apathetic,
mentally retarded, incapable normal movement,
speech, hearing.
• IDD in pregnant women may cause miscarriage,
stillbirth, and mental retardation in infants.
• Iodine cannot be stored for long periods by
the body, tiny amounts are needed regularly.
• In areas of endemic Iodine deficiency, where
soil and therefore crops and grazing animals
do not provide sufficient dietary iodine to the
population, food supplementation have
proven to be highly successful and sustainable
interventions
• The fortification of salt or oil with iodine is the
most common tool to prevent IDD.
• Iodized salt that is commercially packaged in
plastic sacks and not stored properly can lose
its concentration of iodine.
Goiter
• Enlargement of the thyroid gland during
extended iodine deficiency.
• The thyroid gland works to compensate for
the low Iodine levels and expands.
• Goiter frequently remains even after iodine
intake is again sufficient.
• The incidence of goiter in certain populations is
endemic or regionally defined in areas where Iodine
was unavailable in soil and water, in areas far away
from the ocean.
• Goiter may also be caused by the action of
goitrogens. When consumed as a staple component
of dietary intake, goitrogens (substances in the root
vegetable cassava and in cabbage) suppress the
actions of the thyroid gland. Goitrogens are
destroyed by certain preparation techniques.
• Too much iodine cause iodine induced goiter
called thyrotoxicosis. Safe levels are at
1100mcg.
 Causes of Malnutrition
• Biologic factors affect the ability of the body to
use nutrients.
• Economic effects encompass the ability to
purchase food and also consider the structure
of a country’s economy and access to
employment.
• Environmental factors directly affect the
availability of food as related to crop production
and crop safety
• Lack of education, social isolation, and effects
of unemployment.
 Priority Nutrition Interventions in Zambia

• Infant and Young Child Feeding

• Adequate vitamin A, Iron and Iodine Intake.
• Integrated Management of Acute Malnutrition
• Nutrition and HIV/AIDs
• Baby Friendly Hospital Initiative
• Food Supplimentation