Malnutrition in Pakistani Children

1
Malnutrition in Pakistani Children

• Dr. Nayyar Raza Kazmi
• M.B.,B.S, D.H.P.M, M.Sc

2
What is Malnutrition

• Malnutrition is defined as a pathological state
  resulting from relative or absolute deficiency of
  one or more essential nutrients. It is primary
  when there is deficiency of food available or
  secondary when food is available but the body
  cannot assimilate it for one or another reason.
• Malnutrition is common in children between age of
  3 months and 3 years.
• Malnutrition is classified into
• Marasmus It is caused by a diet deficient in
  Calories
• Kwashiorkor It is caused by a diet primarily
  deficient in Proteins. Weight loss may not be
  much prominent in Kwashiorkor because the loss is
  heralded by Edema.

3
Anthropometric Indices in Malnutrition

• Weight for age is the best screening tool.
• Weight for age below 2 Standard Deviation from
  median is taken as Malnutrition.
• It is used for mass screening of children to
  detect under nutrition.
• Weight for Height below the 5th Centile
  classifies the child as Wasted ( Acute
  Malnutrition).
• Height for age below the 5th centile classifies
  the child as Stunted (Chronic Malnutrition)

4
Malnutrition in Pakistan

• 38 of Children are Low Weight for Age.
• 14 of Children are Wasted
• 36 or Urban and 44 of rural Children are
  Stunted.
• Malnutrition is responsible as underlying factor
  for 55 of Deaths in Children under 5 years of
  age.

5
Etiology of Primary Malnutrition

• Failure of Lactation.
• Improper Weaning Practices
• Poverty
• Food Taboos
• 2 or more children under 5 years of age in same
  household
• Death of Mother
• Incompetent/ Ignorant Mother.
• Lack of Family Planning

6
Etiology of Secondary Malnutrition

• Lack of Immunization
• Congenital Diseases ASD, VSD, cleft palate etc.
• Malabsorption Celiac Disease, Lactose
  intolerane, Giardiasis, Cystic Fibrosis
• Metabolic Inborn errors of Metabolism, CRF,
  Renal tubular Acidosis etc.
• Tuberculosis ( very common in Pakistan)

7
Clinical features in Marasmus

• Marked muscle wasting and loss of subcutaneous
  fat.
• Monkey Facies
• Skin becomes loose and hangs in folds
• Abdomen protuberant due to hypotonic muscles
• Temperature is usually sub-normal
• Child is alert

8
Clinical features of Kwashiorkor

• Generalized Edema
• Apathy and Irritability
• Fine, sparse and discoloured hair
• Anemia
• Usually Flaky Paint Dermatitis
• Enlarged Liver due to Fatty Changes

9
Lab Investigations in Malnutrition

• Check Hemoglobin in all cases. It is usually low.
  Sometimes it may be normal despite severe pallor
  in child because of the associated dehydration
  and hemoconcentration, the Hb apparently seems to
  be normal.
• If there is no BCG Scar, do Diagnostic BCG and
  read after 72 hours. If more than 10 mm of
  induration, treat as Tuberculosis.
• Do Stool R/E and Urine R/E.
• Do Chest Xray in all cases of Malnutrition.
• Serum Pre-Albumin level. This is the most
  sensitive prognostic indicator in Kwashiorkor. Do
  on Day1, Day 5 and before discharge of the
  patient.
• Plasma Protiens and Serum Albumin level. These
  are usually very low in Kwashiorkor.

10
Complications of Malnutrition

• Hypothermia
• Hypoglycemia
• Cardiac Failure
• Infections
• Vitamin A Deficiency
• Severe Anemia
• Dermatosis

11
Treatment of Malnutrition

• Follow WHO Guidelines
• 1.Treat/prevent hypoglycaemia
• 2. Treat/prevent hypothermia
• 3. Treat/prevent dehydration
• 4. Correct electrolyte imbalance
• 5. Treat/prevent infection
• 6. Correct micronutrient deficiencies
• 7. Initiate refeeding
• 8. Facilitate catch-up growth
• 9. Provide sensory stimulation and emotional
  support
• 10. Prepare for follow-up after recovery