Introduction

Malnutrition refers to deficiencies or excesses in nutrient intake, imbalance of essential nutrients or impaired nutrient utilization.¹ It is a significant public health problem and a major cause of mortality and morbidity in children below 5 years of age. The proportion of this disease is much higher in sub-Saharan countries than in other geographical regions globally.²

In 2018, stunting affected an estimated 149 million children under the age of 5 years, while wasting affected 49 million children. Around 45% of deaths among under-five children are linked to undernutrition. These mostly occur in low and middle-income countries. Every country in the world is affected by one or more forms of malnutrition. Combating malnutrition in all its forms is one of the greatest global health challenges. Women, infants, children and adolescents are at the highest risk of malnutrition. Optimizing nutrition early in life ensures the best possible start in life with long-term benefits.¹

Prevalence of child malnutrition by residence, Nigeria. Available at: https://www.researchgate.net/publication/46442031_Patterns_and_trends_of_child_and_maternal_nutrition_inequalities_in_Nigeria

Classification of malnutrition.

Protein Energy Malnutrition (PEM)

Protein Energy Malnutrition is common in connection with chronic disease and is associated with increased morbidity and mortality, PEM applies to a group of related disorders that include marasmus, kwashiorkor and intermediate states of marasmic-kwashiorkor.³

Source: https://emedicine.medscape.com/article/1104623-overview

Marasmus is characterized by severe wasting, it represents an adaptive response to starvation. Marasmus occurs when there is an insufficient energy intake to match the body’s requirements as a result the body draws on its own stores, resulting in emaciation.³

Children may also present a mixed picture of marasmus and kwashiorkor or with milder forms of malnutrition which may be acute, chronic or acute and chronic.³

Acute malnutrition (wasting): Children with severe acute malnutrition have very low weight for their height and severe muscle wasting, they may also have nutritional oedema- swollen feet, face and limbs4. Children suffering from wasting have weakened immunity, are susceptible to long term developmental delays and face an increased risk of death particularly when wasting is severe.6

·Chronic malnutrition (stunting): Chronic malnutrition results from insufficient intake or absorption of essential nutrients over a long period, stunting (low height for weight) is associated with developmental impairments and reduced economic potential later in life5. Children suffering from stunting may never attain their full possible height and their brains may never develop to their full cognitive potential, they face learning difficulties in school, earn less as adults and face barriers to participate in their communities6.

. Acute and chronic malnutrition(underweight): Children with acute and chronic malnutrition have very low weight for age.

· Childhood overweight and obesity: This is an emerging face of malnutrition, there are now about 38.3 million overweight children globally with an increase of 8 million since 2000. The emergence of overweight and obesity has been shaped by greater access to processed foods along with lower levels of physical activity.6

Source: comparison of normal wasted and stunted child  available at: https://www.imtf.org/has-the-prevalence-of-stunting-in-south-african-children-changed-in-40-years-a-systematicreview/comparison_of_normal_wasted_and_stunted_child/

Risk factors of malnutrition

· Inadequate dietary intake by mother and child may lead to malnutrition.

· Non-exclusive breastfeeding

· Foetal growth restriction in mother as a result of insufficient intake of minerals and vitamins needed for growth.

· Inadequate sanitation in areas where open defecation is practiced which leads to recurrent diarrhoea.

· Lack of parental knowledge on healthy nutrition and environment.

· Incomplete vaccination in children

·  Poverty; inability to afford even the cheap and available food items.

· Environmental instability and emergency situations such as famine.5

Effects of malnutrition in under-five children

Malnutrition in children is extremely harmful and its effects may include;

· It impedes physical developments

· It leads to an impaired brain development and function.

· Malnutrition leads to poor school performance which can result to low income in future.

· Weakened immune system which increases vulnerability to diseases.

· Vitamin A deficiency leads to vision problem in children such as dry eyes, night blindness and dying corneas.6

Solutions to malnutrition

·  Adequate maternal nutrition before/during pregnancy and lactation

· Availability of healthy environment which includes access to basic health, safe drinking water and sanitation services.

· Adequate awareness on healthy nutrition

· Proper vaccination for children

· Exclusive breast feeding

·Proper antenatal and postnatal care.

Conclusion

Malnutrition has been identified as a major threat to the health and development of population worldwide. Under-five children are more vulnerable to diseases and death resulting from inadequate access to essential nutrients and healthy environment in developing, low-middle income countries, the common risk factors include lack of parental knowledge on healthy habits, nutrition and environmental hygiene.

At Eat Right Society, we envision a society where generations are able to prevent, abate and reverse harmful effects of nutritional malpractices, unhealthy habits, environmental pollution and sanitation thereby living quality and longer lives. As part of our initiatives, we achieve this through our Organic Foods Initiative Programme (OFIP), Blanket Supplementary Feeding Programme among vulnerable Populations (BSFP), Food Incompatibilities Programme (FIP), Eating Disorders Recovery Programme (EDR) and Deworming, Handwashing and Oral Care Promotion Programme (DOHCA).

Malnutrition  is  a  significant  public  health  problem  and  it  is  an  important  cause  of  morbidity  and  mortality  in children below 5  years of age. The proportion of this disease  is much higher in sub-Saharan  countries than in other geographical  regions globally.

Malnutrition can be caused by deficiencies, excesses, imbalances in an  individual’s  consumption  of  nutrients .1  Malnutrition  can  be under nutrition or  over  nutrition,2 but in  this review, malnutrition solely  refers to  the  deficiency of  nutrition. One  of  the major  health problem  faced  by  children  in  developing  countries  today  is  under nutrition. 3-5

REFERENCES

1. WHO (2020) Overview of malnutrition; available at https://www.who.int/health-topics/malnutrition#tab=tab_1

2. Ozoka CN (2018) Malnutrition in Children Under 5 Years in Nigeria: Problem Definition, Ethical Justification and recommendation. J Trop Dis, 6: 268, available at https://www.researchgate.net/publication/327598095_Burden_of_Malnutrition_in_Children_Under_5_Years_in_Nigeria_Problem_Definition_Ethical_Justification_and_Recommendations

3. Hadi Atassi, Thomas L Abell, MD (2019) Protein-Energy Malnutrition
available at https://emedicine.medscape.com/article/1104623-overview

4. UNICEF (2015) Nutrition available at https://www.unicef.org/nutrition/index_sam.html

5. Lindsey Lenters, Kerri Wazny and Zulfiqar A Bhutta (2016) Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2). Chapter 11, Management of Severe and Moderate Acute Malnutrition in Children. Available at https://www.ncbi.nlm.nih.gov/books/NBK361900/

6. UNICEF/WHO/World Bank Group (2020)   Levels and Trends in child malnutrition
Joint Child Malnutrition Estimates, 2020 edition.  Available at https://www.unicef.org/reports/joint-child-malnutrition-estimates-levels-and-trends-child-malnutrition-2020

7. UNICEF For Every Child. Malnutrition available at https://www.unicef.ca/en/malnutrition

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