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Understanding malnutrition

Understanding malnutrition. Key Messages. The term malnutrition covers a range of conditions resulting from an inadequate diet and/or infection

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Understanding malnutrition

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  1. Understanding malnutrition

  2. People Empowerment Advocacy & communal Harmony (PEACH) Key Messages • The term malnutrition covers a range of conditions resulting from an inadequate diet and/or infection • Chronic or long-term malnutrition is the most common form of malnutrition and causes ‘stunting’ (short individuals); It is an irreversible condition • Acute malnutrition or ‘wasting’ (thin individuals) can be reversed and is of particular concern during emergencies because it can quickly lead to death • Severe acute malnutrition (SAM) has two clinical forms: marasmus and kwashiorkor. Marasmus is characterised by severe wasting whilst kwashiorkor is characterised by bilateral oedema (swelling on both sides) • Malnutrition is closely associated with disease and death

  3. People Empowerment Advocacy & communal Harmony (PEACH) Key Messages … • Young children, pregnant and breastfeeding mothers, and those suffering from chronic illnesses are most vulnerable to malnutrition • Vulnerability of children to malnutrition is related to their body composition • Malnutrition rates, both chronic and acute are higher in South Asia than in anywhere else in the world

  4. People Empowerment Advocacy & communal Harmony (PEACH) WHAT IS MALNUTRITION? Malnutrition • Over-nutrition (obesity) and under-nutrition (Kwashiorkor and Marasmus) • Wasting, stunting and deficiencies of essential vitamins and minerals collectively referred as micronutrients Deficiency common in: • Low-income groups • Developing countries (strongly associated with poverty)

  5. People Empowerment Advocacy & communal Harmony (PEACH) Malnutrition … Food provides the nutrients: • Growth • Maintenance of body functions such as breathing, digestion and keeping warm • Repair of the body • Keeping the immune system healthy Categories of nutrients needed by the body: • Macronutrients- needed in large amounts and include protein, carbohydrate and fat • Micronutrients - needed in much smaller amounts and include vitamins and minerals

  6. People Empowerment Advocacy & communal Harmony (PEACH) Malnutrition … • Malnourished people are more susceptible to infections and disease • Infections - particularly in young children • Disease patterns are affected by seasonal changes • Increased rainfall and changes in temperature all have an impact on disease In emergencies, the risk of diseases also increase due to: • Overcrowding in camps • Inadequate sanitation • Poor water supply • Lack of health care

  7. People Empowerment Advocacy & communal Harmony (PEACH) Chronic malnutrition Chronic malnutrition - over the long-term • Also known as stunting, is a sign of ‘shortness’ and develops over a long period of time • In children and adults, it is measured through the height for age nutritional index • Chronic malnutrition is due to insufficient intake of some nutrients • 800 million people world wide (UNICEF) • Children under the age of five are particularly affected • Referred as ‘silent malnutrition’ • Chronic malnutrition has intergenerational implications • Stunted (short) women are more likely to give birth to low birth weight babies (of less than 2.5 kgs)

  8. People Empowerment Advocacy & communal Harmony (PEACH) Acute malnutrition Acute malnutrition- short time • Also known as wasting, is a sign of ‘thinness’ and develops as a result of recent rapid weight loss or a failure to gain weight • In children, it is measured through the weight for height nutritional index • In adults it is measured by body mass index or mid upper arm circumference • Reduces resistance to disease • Impairs bodily functions • Acute malnutrition is much less common than stunting • In African countries, the average rate of acute malnutrition is 8% • In Asian countries, the average rate of wasting is as high as 14%

  9. People Empowerment Advocacy & communal Harmony (PEACH) Acute malnutrition … • In Europe the rate of acute malnutrition is 1% • There are an estimated 19 million children with severe acute malnutrition in low and middle income countries who are at increased risk of dying Acute malnutrition leads to changes in: • Body composition • Cell, tissue and organ functions • Cellular composition • The most visible consequence of acute malnutrition is weight loss • In children this is often combined with growth failure • Pregnant women with acute malnutrition may fail to gain weight

  10. People Empowerment Advocacy & communal Harmony (PEACH) Clinical forms of acute malnutrition Nutritional status can be measured by: • Clinical signs • Anthropometric (body) measurements • Biochemical markers Acute malnutrition is distinguished by its clinical characteristics • Marasmus – severe weight loss leaving ‘skin and bones’ • Kwashiorkor – bloated (swollen, puffed off) appearance due to water accumulation (oedema) • Marasmic-kwashiorkor – a combination of both

  11. People Empowerment Advocacy & communal Harmony (PEACH) Clinical forms of acute malnutrition …. Marasmus • Severe wasting of fat and muscles which the body breaks down to make energy leaving ‘skin and bones’ • Common form of acute malnutrition in nutritional emergencies 

  12. People Empowerment Advocacy & communal Harmony (PEACH)

  13. People Empowerment Advocacy & communal Harmony (PEACH) Clinical forms of acute malnutrition …. Kwashiorkor • Bilateral oedema - affecting both sides of the body • Sometimes accompanied by a skin rash and changes in hair and skin colour-greyish or reddish

  14. People Empowerment Advocacy & communal Harmony (PEACH) Clinical forms of acute malnutrition …. Oedema • Excessive accumulation of extra-cellular fluid in the body which results from severe nutritional deficiencies • Oedema is present when the leg is pressed with the thumb just above the ankle, and a definite pit remains after three seconds • Recent accepted theories suggest that antioxidants and other essential nutrients such as iron, folic acid, iodine, selenium and vitamin C are helpful to cure kwashiorkor Marasmic-kwashiorkor • Marasmus and kwashiorkor • Characterized by severe wasting with bilateral oedema

  15. People Empowerment Advocacy & communal Harmony (PEACH) Clinical features of severe acute malnutrition

  16. People Empowerment Advocacy & communal Harmony (PEACH) Who is most vulnerable to malnutrition during an emergency? The population groups most nutritionally vulnerable in emergencies can be categorised according to their: • Physiological vulnerability • Geographical vulnerability • Political vulnerability • Internal displacement and refugee status The cycle of malnutrition • Inter-generational component of malnutrition • Poor growth can be transmitted from one generation to the next • Small women tend to give birth to small babies who, in turn, are more likely to become small children, small adolescents and, ultimately, small adults

  17. People Empowerment Advocacy & communal Harmony (PEACH) Physiological vulnerability Physiological vulnerability includes: Individuals with increased nutrient requirements • Low birth weight babies • 0-24 month old children • Pregnant and breastfeeding women Individuals with reduced appetites • Older people, the disabled and people with chronic diseases • People living with HIV and AIDs

  18. People Empowerment Advocacy & communal Harmony (PEACH) Nutrition throughout the life cycle

  19. People Empowerment Advocacy & communal Harmony (PEACH) The distribution of underweight throughout the world CEE/CIS = Central and Eastern European Countries/ Commonwealth of Independent States

  20. People Empowerment Advocacy & communal Harmony (PEACH) People living with HIV and AIDS Malnutrition and HIVdirectlyaffect each other and lead to: • Weight loss - especially loss of muscle tissue and body fat • Vitamin and mineral deficiencies • Reduced immune function and competence • Increased susceptibility to secondary infections • Increased nutritional needs - because of reduced food intake and increased loss of nutrients leading to rapid HIV disease progression

  21. People Empowerment Advocacy & communal Harmony (PEACH) People living with HIV and AIDS …. People already infected with HIV are at greater risk of physically deteriorating because of a number of factors • Reduced food intake due to appetite loss or difficulties in eating • Poor absorption of nutrients due to diarrhoea; parasites or damage to intestinal cells • Changes in metabolism • Chronic infections • Illness - micronutrients are particularly important in preserving immune function and promoting survival

  22. People Empowerment Advocacy & communal Harmony (PEACH) Countries vulnerable to nutrition emergencies Recently on-going nutritional emergencies in world Africa • Somalia • Sudan • Ethiopia • Democratic Republic of Congo • Southern and Western Africa Asia • Democratic People’s Republic of Korea • Bangladesh • Parts of Pakistan, Afghanistan and Iraq

  23. People Empowerment Advocacy & communal Harmony (PEACH) Conclusion Malnutrition covers a range of disorders including: • Impaired growth • Weight loss and • Micronutrient deficiencies Malnutrition rates frequently rise during emergencies • Lack of access to food • Increased level of infection Principal component of the humanitarian, logistic, management and financial response to an emergency is: Ensuring the nutrition and health needs

  24. People Empowerment Advocacy & communal Harmony (PEACH) Conclusion Important step towards its treatment and prevention • Identification • Classification of malnutrition

  25. People Empowerment Advocacy & communal Harmony (PEACH) The End

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