Acute malnutrition is a devastating public health problem of epidemic proportions. Worldwide, some 55 million children under the age of five suffer from acute malnutrition and 19 million of these from the most serious type – severe acute malnutrition. Every year, 3.5 million children die of malnutrition-related causes.
The human body needs energy and nutrients to function. If food intake is inadequate, the body begins to break down body fat and muscle, the metabolism begins to slow down, thermal regulation is disrupted, the immune system is weakened and kidney function is impaired.
Decreased food consumption, increased energy expenditure and illness result in a poor nutritional state known as malnutrition (or undernutrition). Malnutrition is associated with increased illness and death, reduced educational achievements, productivity and economic capacity, and is one of the principle mechanisms behind the transmission of poverty and inequality from one generation to the next. Malnutrition manifests itself in the form of micronutrient deficiencies, stunting (also known as chronic malnutrition), and/or acute malnutrition. Acute malnutrition is caused by a decrease in food consumption and/or illness resulting in sudden weight loss or oedema.
The most common way to assess malnutrition in children is through body measurements. It is usually diagnosed in one of three ways:
An indicator known as weight-for-height is used to determine whether a child is acutely malnourished. The child’s weight is compared to the ‘normal’ weight for that height. Normal weights for children are determined by studies that have weighed thousands of healthy children. Based on this information, the World Health Organisation (WHO) has developed charts known as international standards for expected growth.
If a child’s weight falls within the range considered normal for his/her height, the child is found to be well-nourished. If the weight is less than the international standards, the child is considered acutely malnourished or wasted.
WHO has created cut-off points to indicate the severity of the malnutrition. If a child’s weight-for-height is less than -2 z-scores (or standard deviations) of normal children, s/he is considered to suffer from moderate acute malnutrition or wasting. If the child’s weight-for-height is less than -3 z-scores (standard deviations) of normal children s/he suffers from severe acute malnutrition and is considered to be severely wasted.
Another measurement used to determine a child’s nutritional status is the mid-upper arm circumference (MUAC) measurement. Because MUAC measurements require a simple, colour-coded measuring band rather than weighing scales and height boards, they are often used during crisis situations. Useful for children between six months and five years of age, a MUAC measurement of less than 12.5 cm indicates that a child is suffering from moderate acute malnutrition. If the MUAC measurement is under 11.5 cm, however, the under-five child’s life may be in danger as he or she is suffering from severe acute malnutrition.
A third way of diagnosing acute malnutrition is by testing for the presence of oedema. Oedema affects a child’s appearance, giving him or her a puffy, swollen look in either lower limbs and feet or face. It can be detected by small pits or indentations remaining in the child’s lower ankles or feet, after pressing lightly with the thumbs. The presence of oedema in both feet and lower legs is always considered a sign of severe acute malnutrition.