Session overview
                   Session overview
     • Overview of malnutrition 
         – Types of malnutrition
         – Strategies of addressing macro and micronutrient 
           deficiencies (supplementation, fortification, dietary 
           diversification and food preparation).
     • Definitions
         – Malnutrition
            • Any condition caused by excess or deficient food energy or 
              nutrient intake or by an imbalance of nutrients.
         – Protein energy malnutrition
            • A range of pathological conditions arising from coincident lack 
              of varying proportion of protein and calories accruing most 
              frequently in infant and young children and commonly 
              associated with infections.
                                       
                                       
                  Types of malnutrition
                  Types of malnutrition
      • Kwashiorkor:
          – A condition resulting due to protein deficient 
            characterized by the oedema, skin and hair 
            changes and usually low body weight for age 
            (<60% weight for age)
      • Marasmus:
          – A condition of starvation to which a child has 
            adjusted by reduces growth.
      • Marasmic kwashiorkor:
          – A condition that develops when the child diet is low 
            in total calories and protein.
                                      
                                      
         CLINICAL SIGNS OF P.E.M.
         CLINICAL SIGNS OF P.E.M.
     •  Marasmus                         •  Kwashiorkor
         – Extreme low weight                – edema of legs, arms and 
         – hunger                              face
         – Extreme wasting                   – wasted weak muscles
         – pot belly                         – enlarged liver
         – an old persons face               – moon face
         – irritability                      – poor appetite
         – Fretfulness                       – pale, sparse hair with weak 
     •  Marasmic-kwashiorkor                   roots
         – extremely low weight              – pale and thin peeling skin
         – oedema
         – other signs of marasmus 
           and kwashiorkor
                                        
                                        
            Micronutrient deficiencies 
            Micronutrient deficiencies 
               common in emergency
                common in emergency
     • Micronutrient deficiency disorders:
         – Iron deficiency (defined as low heamogblobin 
           levels): the most prevalent in refugee camps the 
           world-over due to lack of iron. 
         – Vitamin A deficiency is almost as widespread as 
           anaemia, particularly among populations that depend 
           of food aid. 
         – Zinc Deficiency is increasingly suspected in 
           populations that live mainly on bulk grains for long 
           periods.
                                       
                                       
       Overview of malnutrition cont..
        Overview of malnutrition cont..
     •  Niacin deficiency or pellagra: 
         – is likely to occur among populations that use maize as their main 
            food source. 
     •  Thiamin deficiency or beriberi: 
         – observed in various refugee communities that primarily consume 
            polished rice 
     •  Vitamin C deficiency or scurvy: 
         – is even more localized than beriberi. Almost all outbreaks of 
            scurvy in emergencies have been reported among Ethiopian and 
            Somalis population, principally those who have been cut off for 
            months from camel milk markets. 
     •  Iodine deficiency: 
         – Though uncommon in emergencies, iodine deficiencies may be a 
            problem among populations living in isolated, inland or 
            mountainous areas