Patiente Ngangu, MSF nurse

Democratic Republic of Congo 2017 © Vincenzo Livieri/MSF

Malnutrition

More than 232 million children around the world last year suffered from malnutrition. It is the underlying contributing factor in nearly half of the deaths of children under five years of age.

Putting malnutrition in context

Around 45 percent of deaths among children under 5 years old are linked to undernutrition—which can include wasting, stunting, being underweight, and suffering from deficiencies in vitamins and minerals. These deaths mostly occur in low- and middle-income countries. We can help prevent more children from dying if we change the way food aid is delivered.

When children suffer from acute malnutrition, their immune systems are so impaired that they become more vulnerable to other diseases. Malnutrition is one of the single greatest threats to global public health.

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.

People become malnourished if they are unable to take in enough or fully utilize the food they eat, due to illnesses such as diarrhea or other longstanding illnesses, such as measlesHIV, and tuberculosis.

We estimate that only three percent of the 20 million children suffering from severe acute malnutrition receive the lifesaving treatment they need.

161,400

Malnourished children  

admitted to outpatient feeding programs in 2020

64,300

Severely malnourished 

children admitted to inpatient feeding programs

5

children die

every minute because their diet lacks essential nutrients

Facts about 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 diarrhea can kill a malnourished child. Of the seven million deaths of children under five years of age each year, malnutrition contributes to at least one-third.

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 anemia and therefore exhibit 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, Doctors Without Borders/Médecins Sans Frontières (MSF) takes a preventative approach by distributing supplementary RUTF to at-risk children.

Treating Severe Acute Malnutrition in Chakradharpur block of Jharkhand

How MSF responds to malnutrition

Screening for malnutrition

MSF screens a community for potential malnutrition by conducting nutritional assessments and during almost all of our outpatient and inpatient services not dedicated specifically to nutrition and during other interventions. Our teams assess children by comparing their weight-for-height ratio to international WHO standards, and/or by measuring a child’s mid-upper-arm circumference (MUAC) using color-coded paper bracelets. MUAC measurements are also simple enough to be used at a village level by community health workers.

A revolutionary treatment 

The widespread use of ready-to-use therapeutic food (RUTF), that can be stored long-term without refrigeration and contains a specific balance of nutrients, allows us to more effectively fight against malnutrition. RUTF can be either a paste, much like peanut butter or in a biscuit form. The majority of children can be treated at home by their family with follow-up appointments at a clinic. This strategy can result in cure rates of over 90 percent and reduce referral to inpatient care.

In some regions, our teams run malnutrition prevention projects to stop children falling ill, especially after a yearly “hunger gap”. MSF starts working and sets up outpatient clinics months before malnutrition cases peak at the start of the rainy season.

In areas where malnutrition is likely to become severe, our teams take a preventative approach by distributing a nutritious supplement to at-risk children across Africa and Asia and making sure other disease prevention initiatives, like vaccinations and malaria chemoprophylaxis, are implemented.

Inpatient Therapeutic Feeding Centre (ITFC) at Herat Regional Hospital

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