malnourishment in below 5 years of age

1. MALNUTRITION UNDER 5yr
Presented by – Ashwin Gobbur
Guide – Dr.Shashank

2. SUB - TOPICS
INTRODUCTION
DISEASE BURDEN
PROBLEM STATEMENT
CLASSIFICATION

3. INTRODUCTION
 Malnutrition essentially means “bad nourishment”. It
concerns not enough, as well as too much food, the
wrong types of food, or the inability to use nutrients
properly to maintain health.
 The World Health Organization cites malnutrition as
the greatest single threat to the world's public health.
 Malnutrition in all its forms is a considerable public
health concern and is associated with increased risk of
disease and early death.

4. MALNUTRITION
The WHO defines malnutrition as
"the cellular imbalance between supply of
nutrients & energy and the body's demand
for them to ensure growth, maintenance, and
specific functions”.
Malnutrition comprises both;
 Under nutrition
 Over nutrition

5. TYPES OF MALNUTRITION
 Under nutrition is depletion of energy (calories)
resulting form insufficient food intake over an extended
period of time.
 In extreme cases under-nutrition is called Starvation.
While Famine is severe food shortage of a whole
community.
 Specific Deficiency is the pathological state resulting
form a deficiency of an individual nutrient such as
vitamin A deficiency, iodine deficiency.

6. Over nutrition :
 Many tend to think malnutrition only in terms of
hunger, however, overeating is also a contributing
factor.
 “Over nutrition is the pathological state resulting
from the consumption of excessive quantity of food
over an extended period of time”.
 Overweight and obesity are very common conditions in
developed society and are becoming more common in
developing societies and those in transition.

7. PROBLEM STATEMENT
 47 % of India’s children below 3yr are malnourished
(underweight). The world bank puts the number – at 60
million. This is out of a global estimated total of 146
million.
 27% of indian children under 5yr are categorised as
moderately or severely manourised.
 South Asia has the highest rates- and by far the largest
number – of malnourished children in the world .
 32 babies out of every 1000 born alive - die before their
first birthday.

8. CONTINUED…
At least half of Indian infant deaths are related
to malnutrition, often associated with
infectious diseases.
 Malnutrition impedes cognitive, social,
sensory and motor development - he will be
poor learner and later lower income earner.
 Worst effect occurs during pregnancy and
infancy, here its effects are irreversible.

9. GLOBAL BURDEN

10. Malnutrition Contributing to U 5
Mortality, 2008 (percent)

11. MALNUTRITION IN CHILDREN
Protein energy malnutrition
In children, protein–energy malnutrition is defined
by “measurements that fall below 2 standard
deviations under the normal weight for age
(underweight), height for age (stunting) and
weight for height (wasting)”.
Protein– energy malnutrition usually manifests
early, in children between 6 months and 2 years of
age and is associated with early weaning, delayed
introduction of complementary foods, a low-
protein diet and severe or frequent infections.

12. CLASSIFICATION OF PEM
a. Gomez’ classification : (weight for age)
The child’s weight is compared with a normal child
of same age.
WFA = weight of the child X 100
(%) weight of normal child of same age
Has prognostic value

13. Gomez contd …
• 90–110 % : normal nutritional status
• 75-89 % : mild malnutrition
• 60-74 % : moderate malnutrition
• <60 % : severe malnutrition
Drawbacks :
1. Cut-off of 90% of reference is high, Some
normal children may be classified into mildly
malnourished .
2. Difficult to know if low weight is due to acute
cause or chronic undernutrition.

14. b. Waterlow’s classification :
Waterlow’s classifies two groups for PEM
I. Malnutrition with retarded growth H/A
shortness or stunting
II. Malnutrition with low weight W/A
wasting
W/H
H/A
> M -2 SD <M -2 SD
> M -2 SD NORMAL WASTED
< M -2 SD STUNTED WASTED AND STUNTED

15. CLASSIFICAION DEFINITION GRADING
GOMEZ Weight below %
median WFA
Mild (grade 1) 75%–90% WFA
Moderate (grade 2) 60%–74% WFA
Severe (grade 3) <60% WFA
WATERLOW z-scores (SD) below
median WFH
Mild 80%–90% WFH
Moderate 70%–80% WFH
Severe <70% WFH
WHO (wasting) z-scores (SD) below
median WFH
Moderate -3%</= z-score < -2
Severe z-score < -3
WHO (stunting) z-scores (SD) below
median HFA
Moderate -3%</= z-score < -2
Severe z-score < -3
KANAWATI MUAC divided by
occipitofrontal head
circumference
Mild <0.31
Moderate <0.28
Severe <0.25
COLE z-scores of BMI for
age
Grade 1 BMI for age z-score < -1
Grade 2 BMI for age z-score < -2
Grade 3 BMI for age z-score < -3

16.  Mid arm circumference (MAC):
- Mid pont between olecranon and
acroian process
- Cross tape method
(cm)
- >13.5 ----- satisfactory nutrition
12.5 – 13.5 ----- mild-moderate
<12.5 ----- severely malnourished

17. AWARENESS RIBBON FOR
MALNUTRITION

18. THANK YOU