MDG 1: Eradication of poverty and hunger

Definition of malnutrition
People are malnourished if their diet does not provide adequate calories and protein for growth and maintenance or they are unable to fully utilize the food they eat due to illness (undernutrition). They are also malnourished if they consume too many calories (overnutrition). (Unicef)

Malnutrition
Malnutrition is a contributing factor in over 50% of deaths in children under five
World Bank

Population Density of Underweight Children

(UN)

MUAC
Mid Upper Arm Circumferance SAM <110mm Children 6m-5yrs
Measures Acute malnutrtion

Measure of acute malnutrition

W/H

WASTING
SAM <70% W/H
(<-3 Z-scores)

MAM 70-79% W/H

(<-2 and >= -3 Z-scores)

Measuring Chronic Malnutrition

H/A

STUNTING
<90% of median

Growth of Children <5 years

all children, regardless of ethnic background or regional origin, grow similarly when their needs are met.
(MGRS)

WHO

NCHS 1978
Child Growth References
Measures made 1960-75 American Children- geographically restricted area. With formula milk High socioeconomic background

WHO 2006 Child Growth Standards 1997-2003

de Onis et al. 2004 MDGR

Causes of Malnutrition
Malnutrition/Death
Inadequate dietary intake
MANIFESTATIONS

Disesase
Insufficient Health Services/Unhealthy Environment

IMMEDIATE CAUSES
UNDERLYING CAUSES

Insufficient Household food

Inadequate Maternal Childcare

Political and Economical powers BASIC CAUSES

Modified from UNICEF 1998

Severe Malnutrition
W/H <70% or bilateral oedema
Impaired immune system and electrolyte inbalance Marasmus Kwashiorkor

Kwashiorkor
2-4yrs Comes suddenly after some time of Moderate Malnutrition Low protein intake HG MORTALITET! Symtoms: Bilateral Oedema Apathy Depigmented corse hair, easy to pull. Skin lesions Poor aptetite Diarrhoea
http://www.asnom.org/image/510_nutrition/116_327_kwashiorkor.jpg

Marasmus
1st year of life, often failure to breastfeed.

Lack of proteins and calories.

Body creates energy by dissolving its own tissues Loss of subcutanous fat and muscles. Symtoms:
Wasting W/H <70% Face o an old person Pot belly due to lack of abd. muscles. Anorexia, irritability. Hunger

The evil cycle of Malnutrition

Weight loss Immunity lowered Growth faltering Mucosa damaged

Inadequate Dietary Intake

Apetite loss Nutrient Loss Malabsorbtion
Altered metabolism

Disease: Incidence Severity Duration

Adapted from Andrew Tomkins and Fiona Watson, Malnutrition and Infection, ACC/SCN, Geneva, 1989 , State of the Worlds Childr en 1998

Iodine Deficiency
-Most important cause of brain damage and mental retardation, 760milj have goitre
Deficiency gives hypothyreosis and goitre. Stillbirth and miscarriage Cretinism: mental retardation, stunted, hypothyroidis, deafmutism. Lower IQ by 10-15% Iodising salt

Source: Sea fish, sea weed, Iodized salt

SOURCE: UNICEF

Vit A Deficiency
- Most important cause of blindness in developing
countries Protects skin and mucosa. Increases leucocyte activity. Vit A protects against death in measles with 50% and diarrhoea with 30%. Vit A to newly delivered mothers protects infants <6m against infection. Vision: Scars on conjunctivatotal blindness. Night blindness Treatment lowers the childs risk of dying by 23%!
Bitot spots

http://www.milesresearch.com/

SOURCE: UNICEF

Source: Egg, Liver Butter, cows milk Breast milk. Carotene.

Zinc Deficiency
Active in >80 enzymes Protects skin and mucosa. Increases leucocyte acticity. Zinc supplement reduces the length and severity of diarrhoea by 1/3. Decreases incidence of pneumonia with 12%. Deficiency gives growth failure and increased susceptibility to infections
SOURCE: UNICEF

Source: Whole-grain cereals Legumes Meat Chicken and fish

Iron Deficiency
-Most common micronutrient deficiency in the world affecting 40-50% of children <5years in developing countries. Reduces physical and mental capacities of a population. Lowers immune defence http://www.rcsb.org/pdb/home/home.do Neonates to mothers with anemia have low birth Source: weight and anemia Egg, themselves. Red meat , Paleness, breathlessness, Whole grain bread. tiredness.

SOURCE: UNICEF

Folate deficiency
Vit B9 helps in the formation of red blood cells. Regulates the nerve cells of the embryonic development. Neural tube defect, if deficiency during pregnancy. Low birthweight Preterm delivery Source: Anemia
Liver Kidney Fish, Green leafy vegetables Beans and groundnuts

Spina Bifida

SOURCE: UNICEF

Behandlingsschema Malnutrition (MSF)

Dag
Vit A Zink Sulfat Folsyra Msslingvacc Amoxicillin Albendazol F-75 F-100 F-100+PPN PPN

1 2 3 4 5 6 7 8 9 10
X X X X X X X X X X X X X X X X X X X X X ... ... ... ... ... X X ... X X X X X X

Infant feeding
Breast feeding should be initiated after delivery. Exclusive breastfeeding is recommended to 6 months of age.
Source: WHO

Breast milk advantages

Immunoglobulins (IgA) Macrophages Iron, omega 3-Fatty acids Protects against allergies (eczema, cow milk protein). Sterile, warm! Mother-child bonding
Nelson 2002

Other advantages to Breastfeeding

Cost effective food security

Enough calories, reduces underweight

Increases child spacing by reducing fertillity Empowerement of women Decreased maternal post partum blood loss

Baby Friendly Hospital Initiative

WHO and UNICEF 1991 20 000 facilities 152 countries Promoting breastfeeding through 10 strategies.
-Written policies -Educating staff and mothers -Initiate breastfeeding within 30min from delivery, skin to skin. -Exclusive breastfeeding -Rooming in: mothers and babies together 24 hrs after delivery -Breastfeeding support groups

UNICEF and WHO report BFHI, Jan 2006

Should HIV positive mother breastfeed?

10-20% risk of HIV transmission by Iron deficiency breastmilk during one year of breast feeding. Pneumonia Must be weighed against the risk of child dying from diarrhoea or other diseases

Swedish supplementation
Vit K injektion till alla nyfdda barn, skyddar mot hjrnbldning Vit A+D i ADdroppar frn 1 mn2 r samt alla skolbarn under mrka vinterhalvret.
Lkemedelsboken 2007/2008

Vad har detta barn fr diagnos?

http://upload.wikimedia.org/wikipedia/commons/4/47/Starved_girl.jpg

References
UN Millennium Project 2005, Halving Hunger http://devdata.worldbank.org/atlas-mdg/ http://upload.wikimedia.org/wikipedia/commons/4/47/Starved_girl.jpg de Onis M, Garza C, Victora CG, Bhan MK, Norum KR, guest editors. The WHO Multicentre Growh Reference Study (MGRS): Rationale, planning and implementation. Food and Nutrition Bulletin, Volume 25, Number 1, Supplement 1, March 2004 . http://www.unu.edu/unupress/food/fnb25-1s-WHO-1.pdf Growth Chart : http://www.who.int/nutrition/media_page/growthchart/en/ Refugee Health: An approach to Emergency Sitations, MSF 1997 http://www.asnom.org/image/510_nutrition/116_327_kwashiorkor.jpg State of the Worlds Children 1998, UNICEF http://www.milesresearch.com/main/eyesigns.asp#bitotspots Micronutrient deficiencies: Bringing science to bear. Global Strategy for Infant and young Child feeding, WHO, Geneva Essentials of Pediatrics, Nelson 4th edition 2002. http://encarta.msn.com/media_461516710_761575681_1_1/macrophage_engulfing_bacterium.html http://www.avert.org/aids-picture.php?photo_id=1703, Photo of antibody. Global Health and introductory text book, Lindstrand et.al. 2006. (cost of iodizing salt) The revised BFHI package includes: Section 1: Background and Implementation [pdf 359kb], 2006, http://www.who.int/nutrition/topics/bfhi/en/index.html

http://upload.wikimedia.org/wikipedia/commons/b/bb/Zinc_Sulfat e.jpg