Childhood acute malnutrition - from basics to delivery of interventions

Acute malnutrition or wasting is defined as a weight-for-height or length below 2 standard deviations of the WHO child growth standard. The severe form - severe acute malnutrition (SAM)- is characterized by a weight-for-height or length below 3 SD, or bilateral pitting edema, or a mid-upper arm circumference (MUAC) less than 115 mm.

Moderate acute malnutrition (MAM) is diagnosed if a child has either a weight-for-height Z score between -3 to -2 SD or a MUAC between 115 to 125 mm. Acute malnutrition affects 8% or 52 million under-five children globally. SAM affects 3% of children globally which accounts for 19 million children. The overall odds ratio for mortality associated with SAM and MAM are 9.4 and 3 respectively.

We have recently shown in Bangladeshi children with SAM and MAM that their microbiota is immature compared with healthy children living in similar socioeconomic conditions (Nature 2014 doi:10.1038/nature13421). The immaturity of the microbiota is improved with either with a peanut-based ready-to-use therapeutic food (RUTF, Plumpy’Nut) or with local cereal-based diets (Halwa and Khichuri). However, it then regresses during follow up after treatment. We believe that this microbiota immaturity has an impact on the metabolism of the child, on the immune system, cognitive functions and on functional aspects such as poor efficacy of orally administered vaccines.

We have developed RUTF using locally available food ingredients, and the new RUTFs are as efficacious as those commercially produced. The challenge now is to use the existing health system to identify children with SAM in the community, refer those who are acutely ill to a health facility for hospital-based care, and treat those who are not acutely ill at home with locally made RUTF. Caregivers of children with MAM should be counseled to give appropriately nutritious diet, micronutrients, and vaccines against common childhood illnesses.