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Malnutrition

Medical nutrition programs are an important part of Doctors Without Borders/Médecins Sans Frontières (MSF)'s emergency medical care in many of the more than 60 countries around the world where we operate. This includes emergency interventions in several countries currently facing urgent malnutrition crises, including South SudanNigeriaYemen and Chad

Malnutrition causes nearly half of all child deaths globally every year, but has complex root causes. In the Sahel region of central Africa, an annual hunger gap between harvests puts thousands of children at risk of malnutrition, while in countries from South Sudan to Afghanistan conflict and displacement is a driving force behind spreading malnourishment.

Nine children die every minute because their diet lacks essential nutrients. They will continue to do so unless food aid changes. MSF admitted 181,600 malnourished children to nutrition programs in 2015.

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In some places where MSF provides malnutrition response, the established international medical malnutrition protocols may be ill-suited to the realities on the ground. One recent example was in Nigeria's Borno State, where conflict between government forces and the militant group Boko Haram created an extreme displacement and nutrition crisis, and where it was difficult for our medical teams to have predictable access to patients. In that case, MSF adapted its approach by employing the "One Shot" strategy in order to create better outcomes in the face of significant security constraints. 

Kerstin Hanson, a nutrition and pediatrics technical advisor for MSF in Paris, recently explained the challenges and the solutions in the Lancet's Global Health Blog.

Who is most at risk from malnutrition?

When children suffer from acute malnutrition, their immune systems are so impaired that the risk of death is greatly increased. According to the World Health Organization (WHO), malnutrition is the single greatest threat to the world’s public health. WHO estimates that 178 million children under five are malnourished.

The critical age for malnutrition is from six months — when mothers generally start supplementing breast milk with other foods — to 24 months. However, children under five, adolescents, pregnant or breastfeeding women, the elderly and the chronically ill are also vulnerable.

People become malnourished if they are unable to take in enough food. They may also become malnourished if they are unable to fully utilize the food they eat, perhaps due to illnesses such as diarrhea, measles, HIV and tuberculosis.

We estimate that only three per cent of the 20 million children suffering from severe acute malnutrition receive the lifesaving treatment they need.

 In 2011, former MSF Canada director Marilyn McHarg, responding to fundraising campaigns connected to a malnutrition crisis in Somalia, described why MSF considers such crises to be about more than simply famine and drought, and why we think it is important to highlight the complexities of these situations and the reasons for our interventions.

Read more about MSF's work with malnutrition in a special edition of Dispatches, the MSF Canada magazine

The Fall/Winter 2016 edition of Dispatches, the MSF Canada magazine, was organized around the theme of malnutrition, and how MSF is responding to nutrition emergencies in Chad, Nigeria and elsewhere in the world.

What causes malnutrition?

Breast milk is the only food a child needs for its first six months. Beyond this point breastfeeding alone is not sufficient. Diets at this stage must provide the right blend of high-quality protein, essential fats and carbohydrates, vitamins and minerals.

In the Sahel, the Horn of Africa and parts of South Asia, people are often unable to access highly nutritious foods such as milk, meats and fish. The diets of children under the age of two have a profound impact on their physical and mental development. Malnourished children under the age of five have severely weakened immune systems and are less resistant to common childhood diseases.

This is why a common cold or a bout of diarrhea can kill a malnourished child. Of the eight million deaths of children under five each year, malnutrition contributes to at least one third.

Hover above the image below for an interactive guide to malnutrition:

 

Symptoms of malnutrition

The most common sign of malnutrition is weight loss. Loss of weight may also be accompanied by a lack of strength and energy and the inability to undertake routine tasks. Those who are malnourished often develop anemia and therefore a lack of energy and breathlessness.

In children, signs of malnutrition may include an inability to concentrate or increased irritability and stunted growth. In cases of severe acute malnutrition, swelling of the stomach, face and legs and changes in skin pigmentation may also occur.

Diagnosing malnutrition

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Malnutrition is diagnosed by comparing standard weights and heights within a given population, or by the measurement of a child’s mid-upper arm circumference.

If dietary deficiencies persist, children will stop growing and become stunted — meaning they have a low height for their age. This is diagnosed as chronic malnutrition.

If they experience weight loss or wasting — low weight relative to their height — they are diagnosed with acute malnutrition. This weight loss occurs when a malnourished person begins to consume his or her own body tissues to obtain needed nutrients.

Treating malnutrition

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We believe that ready-to-use therapeutic food (RUTF) is the most effective way to treat malnutrition. RUTFs include all the nutrients a child needs during its development and helps to reverse deficiencies and add weight. RUTFs don’t require water for preparation, which eliminates the risk of contamination with water-borne diseases.

Because of its packaging, RUTFs can be used in all kinds of settings and can be stored for long periods of time. Unless the patient suffers from severe complications, RUTFs also allow patients to be treated at home.

Where malnutrition is likely to become severe, we take a preventative approach by distributing supplementary RUTFs to at-risk children.

Photo story: Treating Gatluok, a severely malnourished child in South Sudan

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Gatluok was the name of a severely malnourished child who arrived at MSF's therapeutic feeding centre in Leer, South Sudan, in 2014. Within a week of his arrival, he was on the road to recovery.