Food Is Not Enough campaign - Understanding malnutrition
Malnutrition affects first and foremost children under the age of two, but young children less than five years of age, adolescents, pregnant or lactating mothers, the elderly and the chronically ill (including those with HIV/AIDS and TB) are also vulnerable.
What is malnutrition?
Malnutrition is often lost in discussions around the subject of hunger, especially in the context of the discourse to "end world hunger," or to "feed the world." These blurred definitions help perpetuate the inadequate response to malnutrition. It is crucial to distinguish between malnutrition and hunger, as malnutrition requires responses that go beyond food aid.
Hunger is usually taken to mean a deficiency in caloric intake - any person whose daily diet gives fewer than the defined minimum of 2,100 kcal is considered suffering from hunger, or undernourished. The typical response to hunger is food aid that supplements a person's daily caloric intake.
Malnutrition however is not merely the result of too little food. It is a pathology caused principally by a lack of essential nutrients. Most food aid is an inadequate response to malnutrition as it either delivers insufficient amounts of essential nutrients or delivers them in a way that they are destroyed by cooking or not taken up properly by the body.
Who is most at risk?
Malnutrition affects first and foremost children under the age of two, but young children less than five years of age, adolescents, pregnant or lactating mothers, the elderly and the chronically ill (including those with HIV/AIDS and TB) are also vulnerable. Children are especially susceptible to growth failure when foods have to be introduced to complement breastfeeding in the first and second years of life. Wasting and other forms of acute malnutrition often appear among children in seasonal cycles, especially during the 'hunger gap' period between harvests.
"When children suffer from acute malnutrition, their immune systems are so impaired that the risks of mortality are greatly increased. A banal children's disease such as a respiratory infection or gastro-enteritis can very quickly led to complications in a malnourished child and the risks of death are high."
- Dr. Susan Shepherd, MSF Medical Coordinator for the nutritional programme in Maradi, Niger
How is malnutrition identified?
Malnutrition is defined in three ways: by a weight for height indicator with a reference population, or mid-upper arm circumference (MUAC), or by the presence of oedema (a bloated appearance to the feet and face).
If dietary deficiencies are persistent, children will stop growing and become stunted (low height for one's age). This is referred to as chronic malnutrition. If they experience weight loss or 'wasting' (low weight for one's height), they are described as suffering from acute malnutrition. Both of these presentations of malnutrition may be further classified as moderate or severe.
Severe acute malnutrition includes two main clinical forms - severe wasting (called marasmus) and nutritional oedema (known as kwashiorkor). It is the clinical analysis that determines if treatment will be in hospital or with therapeutic RUF at home. MSF experience in Niger has been that most children do not have complications and can therefore follow therapeutic RUF treatment at home. Severe acute malnutrition has a case fatality rate of up to 21% without effective intervention. But any child with malnutrition is at an increased risk of developing complications leading to severe illness and death.
What are the consequences of malnutrition?
Malnutrition is associated with half of all deaths in children under the age of five each year. The risk of death is particularly high for children with severe acute malnutrition, up to 20 times higher than a healthy child.
What is the global burden of malnutrition?
In developing countries 146 million children under the age of five are underweight, as defined by weight for age (one in four children). Sixty million children under the age of five are wasted (almost one in ten children).
The "malnutrition hotspots" map below combines rates of underweight prevalence, as well as population density of underweight children. It therefore identifies where scarce resources will have a maximum impact.
South Asia, the Sahel and the Horn of Africa are the most alarming hotspots for child malnutrition and mortality. Half of the deaths in children under five in developing countries occur in these regions.