Ministry of Public Health

Session 3: Malnutrition in Afghanistan

Public Nutrition Department Sept 2005

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Objectives• Different types of malnutrition

• Underlying causes of malnutrition

• Intergenerational and seasonal cycles

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So what is malnutrition?

.. malnutrition is a term that covers a wide

range of clinical conditions in children

and adults.

PROTEIN ENERGY MALNUTRITION (PEM) ...a result of deficiencies in any or all nutrients (includes micronutrients, as

well as macronutrients).

MICRONUTRIENT DEFICIENCY DISEASES

(MDD’S) ...occur as a result of deficiencies in specific micronutrients (vitamins or minerals).

Children with PEM all suffer GROWTH FAILURE either:

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Occurs as a result of recent rapid weight loss

or a failure to gain weightACUTE MALNUTRITION

Occurs as a result of inadequate nutrition over a

long period of timeCHRONIC MALNUTRITION

WASTING

(thinness)

STUNTING

(shortness)

Underweight Acute / Chronic

The two clinical forms of PEM:

Marasmic kwashiorkor combines symptoms of marasmus and kwaskiorkor

Kwashiorkor nutritional

oedema.

Marasmus severe loss of body weight or wasting

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Severe wasting

- prominent ribs, spine, scapulae

Thin, flaccid skin hanging in folds

Alert and irritable

Normal hair

Source: NutritionWorks

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Oedema (symmetrica

l oedema involving at

least the feet)

Hair - thinner and lighter

Moon faceNo appetite

Skin lesions

Apathetic and miserable

Source: NutritionWorks

MDDs are associated with specific clinical signs and symptoms.

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Iodine

Iodine deficiency disorders (IDD)

Vitamin A

Xeropthalmia

What are the most common micronutrient deficiency diseases?

Iron

Iron deficiency anaemia (IDA)

Iron deficiency Anemia

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Clinical signs and symptoms:• fatigue, pallor• increased risk of hemorrhaging and maternal

mortality during child birth

Population at Risk:• Women of reproductive age.

Consequences

Vitamin A deficiency

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Clinical signs and symptoms:• Nightblindness, blindness• Weakened immune system results in significantly

increased risk of contracting communicable diseases like measles.

Population at Risk:• Children• Women of reproductive age

Consequences

Iodine Deficiency Disorder

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Clinical signs and symptoms:• Goiter, cretinism, reduced mental capacity

Population at Risk:• Unborn children from women with IDD• widespread in developing countries, especially

in landlocked, mountainous areas.

Consequences

Vitamin C deficiency: Scurvy

At risk • Infants

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Clinical signs and symptoms:• Bleeding easily (gums, bruises)• Swollen joints• Muscle weakness

Consequences

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Conceptual Model of Causes of Malnutrition

Malnutrition

Inadequate Food Intake

Disease

Poor Access to Health Care &

Unhealthy Environment

Immediate Causes

Underlying Causes

Basic Causes

Formal & Informal Infrastructure

Political Ideology

Resources

Household Food

Insecurity

Poor Social and Care

Environment

Adapted from UNICEF

All these are influenced by social, cultural and political determinants, including the level of women’s empowerment

The causes of malnutrition are complex and interconnectedrequires people to work together for

Sufficient availability of, or access to,

affordable, safe and nutritious

FOODthroughout the year

Adequate

CARE for

mothers and children, and

support for mothers on appropriate child feeding practices

Easy and sustained access to

HEALTH

sanitation and clean water services

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Inadequate dietary intake

Appetite lossNutrient loss

MalabsorptionAltered metabolism

Disease:- Incidence- duration- severity

Weight lossGrowth faltering

Lowered immunityMucosal damage

Malnutrition and Infection Cycle

Source: Helen Young, WFP Food and Nutrition Training, Tufts University

RISKS of being malnourished...

Reduced physical activity17

Lowered resistance to disease

Increased risk of mortality

Learning difficulties

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Inter-generation cycle of malnutrition

Child Growth Failure

Low adolescent Weight and

Height

Low Birth Weight Infant

Small Adult Woman

Main messages

• Malnutrition : broad range of conditions• Undernutrition = PEM and MDDs• Visible and invisible consequences • Many challenges• Take into account underlying causes, seasonality and

the intergenerational cycle of malnutrition• Nutrition is everyone’s business

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