You are on page 1of 7

www.actionagainsthunger.

org
© Susana Vera

ACUTE MALNUTRITION
A Preventable Pandemic
Measuring for the Weight/Height Index Measuring the middle upper arm circumference (MUAC) Diagnosing a child with acute malnutrition Marasmus, a type of severe acute malnutrition

WHAT IS ACUTE MALNUTRITION?


Acute malnutrition is a devastating disease
of epidemic proportions. Worldwide, some 55 DIAGNOSING MALNUTRITION TYPES OF ACUTE MALNUTRITION
million children age 5 or younger suffer from
moderate acute malnutrition and 19 million are A DIMINISHED WEIGHT/HEIGHT INDEX Acute malnutrition takes place when the body Severe Acute: The most severe form that
afflicted with severe acute malnutrition—the • A weight/height measurement below doesn’t receive the nutritional support it requires, malnutrition can take, severe acute malnutrition
most dangerous type of hunger.1 Each year, 20% of the mean indicates moderate acute a condition to which it adapts by reducing physical can manifest in two ways:
some 5 million of these children die because malnutrition. activity and slowing the processes involved
• Marasmus: Marasmus is characterized by a massive
they lack access to treatment.2 These deaths are •A weight/height measurement below 30% of in proper organ function and cell and tissue loss of weight and muscle tissue. Due to the
entirely preventable. the mean indicates severe acute malnutrition. maintenance. Regular nourishment enables disequilibrium experienced in weight and height,
human beings to secure the energy their bodies children suffering from Marasmus look almost
Childhood acute malnutrition is as much a medical PRESENCE OF BILATERAL EDEMAS require for the proper functioning of their vital elderly and their bodies are skeletal. At this point,
problem as it is a social problem because it An abnormal accumulation of liquid in one’s organs. Malnutrition occurs when the body their bodies’ vital processes are compromised:
has spent its energy reserves. The body begins their metabolism has slowed, thermal regulation is
directly affects a broad range of issues: a country’s extremities.
disrupted, intestinal absorption and kidney function
mortality rates, educational prospects, productive to consume its own tissues in search of the
are diminished, the liver’s capacity to synthesize
employment, and economic capacity, etc. MIDDLE UPPER ARM CIRCUMFERENCE nutrients and energy it needs to survive, targeting proteins and eliminate toxins is reduced, and the
Malnutrition also happens to be one of the principal An anthropometric measure frequently used muscle and body fat first. The body’s metabolism immunological system doesn’t function properly,
mechanisms behind the transmission of poverty during emergencies is the measurement of begins to slow, thermal regulation is disrupted, which means less resistance to illness and disease.
and inequality from one generation to the next. a child’s upper arm—the MUAC, or Middle kidney function is impaired, and immune system At this stage, even if the child manages to survive its
These devastating consequences also carry a heavy Upper Arm Circumference. Anything less than capacity is diminished. The greater the loss bout with Marasmus, the damage is done and the
of muscle and other tissue, the less likely the deficiencies sustained from the disease can never be
economic cost: it is estimated that productivity losses 12.0 centimeters indicates a child’s life is in
overcome.
alone exceed 10% of a person’s lifetime income, and danger from acute malnutrition. chances of survival. What happens next?
up to 3% of a country’s GDP. • Kwashiorkor: The term “kwashiorkor” comes from
Moderate Acute: Moderate acute malnutrition a Ghanian word that means “the sickness the older
affects a greater number of children and has a child gets when the new child is born.” Its principal
Acute malnutrition in children under five years
characteristic is the presence of bilateral edemas
of age increases their risk of death, inhibits their 1
The Lancet: Maternal and Child Undernutrition Series paper 1 greater impact on morbidity. It is accompanied
on the extremities and on the face (a full-faced
physiological and mental development, has life-long January 2008 by crucial deficiencies such as anemia (from a child). Underneath these edemas, the muscles
implications for their health, and heavily mortgages lack of iron), goiter (from a lack of iodine), and have been severely weakened and the child suffers
2
Pelletier DL. The relationship between child anthropometry xerophthalmia (from a lack of vitamin A), as
the opportunities available to future generations. and mortality in developing countries: implications for policy,
from excruciating cramping and muscle pain. These
programs and futures research. N Nutr 1994 (supple): 2047S-81S well as scurvy, pellagra, beriberi (from a lack of children appear apathetic, and are easily irritable
vitamin B), and rickets (from a lack of vitamin D). despite their sorrowful appearance. As is the case
with Marasmus, children with Kwashiorkor suffer
form significant damage to the functioning of their
internal systems.
WHAT CAUSES ACUTE MALNUTRITION?

STRUCTURAL FACTORS TRIGGER FACTORS

ID
M
YRA
POVERTY During the last two decades, extreme TRADE POLICY The major food crises that have VIOLENCE Violence is one of the principal causes

ER P
poverty in Sub-Saharan African has nearly recently buffeted Sub-Saharan Africa stem of acute malnutrition. The disruption of food
doubled, from 164 million in 1981 to some from a lack of access to food, not a lack of production and distribution networks, whether a

G
HUN
313 million as of 2002. Poverty alone does not availability (i.e., the markets are full, but prices deliberate military objective or the consequence
explain the presence of famine, although it does are too high and the poor don’t eat). Prices have of armed conflict, violence is one of the primary

THE
affect the state of food security among the most remained high because much of what is produced causes of severe food shortages, and therefore of ACUTE
vulnerable of populations. domestically is exported while the economic acute malnutrition. MALNUTRITION
powers that control the cereal markets have
GENDER The benefits stemming from the colluded to keep prices high. FAILING STATES Somalia is representative of
education of women constitutes the single the types of crises that can be triggered by the
greatest contribution to the reduction of HIV & AIDS HIV and AIDS have become one of failing of state structures—Somalia being one TRIGGER FACTORS
malnutrition from 1970 through 1995, accounting the primary causes—and consequences—of of the more enduring and costly examples. The Violence
for 43% of all progress made. Women, after malnutrition. An HIV positive child has a faltering of State structures, the absence of basic Failing States
children, are the most susceptible to the ravages greater chance of contracting malnutrition than services, the complete breakdown of public health Natural Disasters
of hunger. his healthier counterparts. Moreover, anti- infrastructure and sanitation systems, have all
retroviral treatments do not perform as well on imposed tremendous suffering on a population with
CLIMATE CHANGE During the 1990s, it is malnourished children, and life expectancy is one of the highest rates of chronic malnutrition in
estimated that natural disasters were responsible considerably shorter for patients who lack proper the world.
for $600 million dollars in losses each year, more diets.
than twice the losses reported during the 1980s. NATURAL DISASTERS When natural disasters STRUCTURAL FACTORS
According to the UN’s Food and Agriculture affect geographic areas with poor structural Poverty
Gender
Organization (FAO), in nearly 40 developing stability, their impacts can be devastating, often
Climate Change
countries, the losses in agricultural production with little relation to the actual magnitude of Trade Policy
attributed to climate change could dramatically the natural phenomenon. Less visible forms of HIV & AIDS
increase the estimated number of people destruction—of productive assets and capacity—
suffering from hunger in the near future. can constrain food supply networks in ways that
are more serious, if less visible, than obvious
effects of a natural disaster.
1 2 3 4
ACUTE MALNUTRITION AROUND
THE WORLD
Countries with the highest incidences of acute malnutrition.
Source: The State of the World’s Children 2008, UNICEF

0% 0-5% 6-10% 11-15% 16-20% ++20%


++20
20
20%%
%

This measuring tape is use


d to measure a child’s mid
estimate in determining dle upper arm circumfere
child’s state of malnutrit nce, a key
ion and risk of death.
DIAGNOSING SEVERE HOSPITAL TREATMENT HOME TREATMENT
ACUTE MALNUTRITION

A
• Child has no appetite
• Has major medical
PHASE 1 TRANSITION PHASE PHASE 2 POST TREATMENT
Administration of therapeutic Administration of therapeutic milk Administration of therapeutic RUFs Children treated for acute
complications
milk formula F-75 to jumpstart formula F-100 until the child’s along with doses of antibiotics, malnutrition are enrolled in
• At least 3 cases of
a child’s metabolism and restore metabolism stabilizes and solid vitamin A, anti-parasite and anti- supplementary nutrition programs
bilateral edema pitting
hydroelectric equilibrium. foods can be introduced. malaria medicines, and measles for an additional four months to
(Kwashiorkor)
vaccinations. ensure total recovery.

B
• Child exhibits appetite
• No major medical
complications
• Fewer than 3 cases of
bilateral edema pitting
(Kwashiorkor)

TREATMENT & PREVENTION:


How is Acute Malnutrition Addressed?
With 30 years of international experience, Action The treatment of acute malnutrition consists of 3 Once they have recovered their appetites
Against Hunger tackles acute malnutrition
READY-TO-USE-FOODS components: and received treatment for their medical
through Community-Based Care outpatient A range of revolutionary Ready-To-Use-Foods complications these children are referred to
programs (“home treatment”), through (RUFs) have been developed in the form of COMMUNITY MOBILIZATION: “HOME VISITORS” the outpatient programs (“home treatment”) to
Stabilization Centers (“hospitals”), and through peanut-butter pastes and biscuits that are To achieve maximum program coverage, continue their regimen, beginning Phase Two.
the development of new Ready-To-Use-Foods nutrient-rich and packed with high concentrations resources must be focused on mobilizing a large The average stay in a hospital setting varies
(RUFs)—both therapeutic and non-therapeutic of energy and calories. These nutrition products number of community volunteers who work between 10 to 15 days, depending on each child’s
nutrition products that children can readily eat reduce exposure to water-borne bacteria because directly with Action Against Hunger’s field teams medical recovery.
any time or place. they contain no water content, i.e., the principal of home visitors. These teams are responsible for
inconvenience associated with the therapeutic identifying early cases of childhood malnutrition THERAPEUTIC OUTPATIENT CARE:
Until fairly recently, children receiving treatment milk formulas used in inpatient care. RUFs so that timely interventions can keep them from “HOME TREATMENT”
for acute malnutrition would recuperate in require no refrigeration, and no heating or deteriorating further. PHASE TWO
intensive-care inpatient facilities called “Therapeutic preparation, all of which ensure that vitamins Children who suffer from severe acute
Feeding Centers,” hospital-like centers where and nutrients aren’t lost by the time they are THERAPEUTIC INPATIENT CARE: malnutrition but who are otherwise clinically
they would remain with a parent or caretaker consumed—not to mention the fuel savings for “HOSPITAL TREATMENT” stable—i.e., present no major medical
during their month-long treatment. The shift poorer households. PHASE ONE + TRANSITION PHASE complications, exhibit fewer than three cases
toward “Community-Based Care” programs, led Children with no appetite and serious medical of edema pitting, and who still possess an
by Action Against Hunger and other international These products are transforming the treatment complications are admitted into specialized appetite—are admitted directly into Phase Two
organizations, allows us to dramatically scale up and prevention of acute malnutrition: their treatment centers, or hospitals. These children and treated in community-based outpatient
coverage, and implies a revolutionary change in the potential for scaled up humanitarian action, for represent about 10-20% of severe acute cases. programs (“home treatment). These children
fight against malnutrition. safe treatment at home, and their effectiveness receive medical supervision during weekly
in the field—a minimum cure rate of 80%—could Once under hospital supervision, these children visits to therapeutic stabilization centers where
The Advantages of Ready-To-Use-Foods (RUFs): spell the end of acute malnutrition as we know it. undergo two phases of treatment. Phase One medical staff evaluate their progress and provide
• RUFs allow for a massive scaling-up of treatment and involves the administration of a specialized milk them with the weekly supply of therapeutic RUFs
prevention programs. formula, F-75, a therapeutic nutritional product needed to continue their home treatment—along
• RUFs allow for increased coverage and broader with a low calorie load designed to jumpstart with doses of antibiotics, vitamin A, anti-parasite
access to treatment.
• RUFs reduce the social costs associated with
a child’s metabolism and restore hydroelectric and anti-malaria medicines, and measles
inpatient treatment, allowing parents to treat a equilibrium. This phase is followed by a Transition vaccinations. The average treatment period lasts
child at home without leaving the family or forgoing Phase in which another milk formula (F-100) about a month and a half but depends on each
income during treatment. is administered until the child’s metabolism child’s progress.
stabilizes and solid foods can be introduced.
ACTION AGAINST HUNGER
Action Against Hunger firmly believes it’s possible to No country can afford to squander their most ACTION AGAINST HUNGER’S EFFORTS IN THE local organizations and building alliances for
put an end to acute malnutrition. Acute malnutrition precious of resources—their human capital. FIGHT TO END ACUTE MALNUTRITION the long term.
in children under five years of age increases their
risk of death, inhibits their physiological and mental How can we expect to build for the future if Each day, hundreds of professionals around the Research and Innovation
development, has life-long implications for their millions of people around the world begin life world work to reduce the number of children who • Continually striving to improve the quality and
health, and heavily mortgages the opportunities without hope or the possibility of prospering? die from acute malnutrition, addressing this issue impact of our work.
available to future generations. Children with acute from a number of vantage points:
malnutrition today are the poor of tomorrow. Political Empowerment
Identification and Diagnosis • To communicate through outreach campaigns
But if acute malnutrition represents a heavy ACF’S POLICY RECOMMENDATIONS • Analyzing the nutritional context, the causes and coordinated activities that acute
mortgage on future generations, then nutrition and risk factors behind malnutrition. malnutrition—the greatest cause of infant
represents an excellent investment opportunity mortality—is perfectly preventable.
• Treatment strategies for acute malnutrition
today. Nutritional improvements reinforce a Treatment and Nutricional Care • To promote access to treatment through
must receive priority within public policy,
population’s productive capabilities, with direct • Through home treatment, community strategies of community-based nutrition
facilitating systematic treatment and access
implications for the process of development and mobilization, and supplemental nutrition programs.
to RUFs.
poverty rates. programs for vulnerable groups, such as • To push for innovation through the research
populations burdened with HIV/AIDS or and development of therapeutic and non-
• Prevention and risk-reduction programs
In 2000, 189 countries ratified the United Nations’ Tuberculosis. therapeutic RUFs.
must be integrated into treatment programs,
eight Millennium Development Goals. Eight years • To establish an integrated approach, from
guaranteeing that underlying causes are
later, global hunger, acute malnutrition, and Prevention and Risk Reduction treatment to prevention, consequences to
addressed.
child mortality rates remain as some of the more • In every axis of intervention: in food security, causes.
urgent challenges confronting the international in productive entrepreneurship, public health
• Retool the international humanitarian
community. and access to water, hygiene, and sanitation.
system to prioritize acute malnutrition: food
aid pipeline strategies, the UN’s nutritional
The Millennium Development Goals of reducing Strengthening Capacity and Sustainability
support, national nutrition protocols, must
global hunger by half and childhood mortality by • Integrating the fight against malnutrition into
all emphasize putting an end to acute
two thirds cannot be realized without prioritizing Ministry of Health programs and public health
malnutrition.
acute malnutrition. structures so they are sustainable over time;
• Transferring our know-how and expertise to

Community-based nutrition education. Treatment of severe acute malnutrition.

The Action Against Hunger


International Network has
launched the Campaign to End
Malnutrition, a public outreach
effort to ensure that the fight
against hunger becomes the
world’s first priority.
Action Against Hunger
247 West 37th Street, Floor 10
New York, NY 10018
212-967-7800
info@ actionagainsthunger.org
www.actionagainsthunger.org

You might also like