GULU UNIVERSITY MEDICAL JOURNAL

Gulu University Medical Journal (GUMJ) 2009/2010 Vol 5.
Malnutrition: A main cause of children’s death!
Luigi Greco, M.Sc. (MCH), M.D., D.C.H., PhD (Hon)
Department of Pediatrics, University of Naples Federico II and European Laboratory for Food Induced Disease
Valentina Fiorito, M.D. Department of Pediatrics, University of Naples Federico II
Malnutrition is one of the greatest public health
problems facing the world today because of the number
of children affected and the long-term consequences.
The World Health Organization (WHO) estimates
that malnutrition contributes to 53% of child mortality
worldwide (1-2). There is a strong association between
malnutrition and mortality in developing countries
because even mild degrees of malnutrition double the
risk of mortality for other diseases such as respiratory
tract infection, diarrhoea, pneumonia, malaria and
measles (3-4) (Figure 1).
Table I shows how WHO defines a patient’s nutritional
status.
Mild Acute Malnutrition benefits of health counselling
and community mobilization.
Moderate Acute Malnutrition is still manageable
in community setting but needs a specific program:
Supplementary Feeding Program (SFP). This program
is based on Supplementary Feeding Centres (SFC) that
monitor every week the patient and provide antibiotics,
antihelminthics, vitamin A and high energy fortified
supplementary food like Ready–to-Use Therapeutic
Food (RUFT).
Severely malnourished children and infants less then
6 months old with specific features (Wt < 4Kg, Wt/
Length< 85% and not able to suckle/not fed on
breast-milk, mother died or mother has no or little
milk or presence of oedema) have to be admitted in
a Therapeutic Feeding Centre (TFC). In this centre
they are managed, according to a specific Therapeutic
Feeding Program (TFP).
Almost all severely malnourished children have
infections, impaired liver and intestinal function, and
problems related to imbalance of electrolytes when
first admitted to hospital. Because of these problems,
they are unable to tolerate the usual amounts of dietary
protein, fat and sodium. It is important, therefore, that
children begin feeding on a diet that is low in these
nutrients, and high in carbohydrate.
To this purpose UNICEF and WHO prepared two
formula diets based on the Modified Cow’s Milk F75
(starter 75 KCal/100 ml) and F100 (follow up 100
KCal/100ml).
These milks are given, in proportion of the body
weight, at 3 hourly intervals. F75 has a moderate
protein and energy content and is given in the early
phase of severe malnutrition, F100 has a higher energy
and protein content and is useful for maintenance. The
milks have to be given frequently and in small amounts
to avoid overloading the intestine, liver and kidneys.
Children unable to drink are fed by plastic syringes
and nasogastric tube. The theoretical daily supply of
energy is 140 to 200 Calories/kg body weight. But
this amount is very difficult to administer to any single
child. Night feeds are generally not available.
Table II shows the composition of the two milk feeds:
F75 starter, to be given for the first few days and F100
for follow up. From the table is clear that the feeds
are based on skimmed milk with added sugar and
vegetable oil.
The mineral mix with potassium, magnesium and
other essential minerals must be added to the diet. The
potassium deficit, present in all malnourished children,
adversely affects cardiac function and gastric emptying.
Magnesium is essential for potassium to enter cells and
be retained. The mineral mix does not contain iron as
this is withheld during the initial phase.
Unfortunately about 95.4% of African children have
the C/C- 13910 genotype of the lactase-Y-phlorizin-
hydrolase gene that causes adult-type hypolactasia (vs
14.5% of Finnish children). The decline of the lactase
activity in African children occurred earlier than
Finnish children, as 30% of the children already had
low levels of lactase (< 10 U/g protein) at the age of
five years (9).
Gulu University Medical Students’ Association (GUMSA) Passion for life 13