Many aetiological factors can lead to PEM:
Economical factors-
Poor economic conditions decrease the food purchasing power. People fail to get basic amount of food. It can cause the failure of growth and development which leads to PEM.
Socio culture factors-
Socio culture factors are the main cause of PEM. Low availability of food leads to PEM.
- Ignorance:-
Ignorance and illiteracy are observed mainly in developing countries. Illiterate people don’t know about the correct and nutritious food. So, it can lead to PEM.
This is another part of socio culture factors. Taboos about food prevent the people to consume correct foods and so children do not get proper nutrition. Besides this, superstitions about food like avoiding particular food item may all cause PEM.
- Caste and religion:-
Caste and religion are also linked with PEM. Hindu, Muslim, Christian, Jain etc are all have different food consumption pattern. So, mothers of children consume food as per her religion which affects the children’s nutrition.
- Social pressure:-
Social pressure involves many rules and regulations for mothers. In many villages widows are not allowed to consume many foods even now-a - days. They are prohibited to eat non vegetarian foods like egg, fish, meat, onion, garlic etc. This can cause PEM.
- Social status:
Who belongs in high status they consume high cost food as compared to someone who belongs in low status but high cost food does not mean the nutritious food. So, it can effect in taking nutritious food.
Health care-
Lack of personal care is the reason of PEM.
Drinking water-
Lack of safe drinking water or poor contaminated water may cause infections. It is retained to poor health status and lead to PEM.
Infections –
Frequent infections such as whooping cough, measles, tuberculosis that show the imbalance of protein and energy in insanitary body.
Urbanization:-
Urbanization makes community crowd that may result lack of food, improper living style, unsanitary condition which is responsible for growth of pathogens which create frequent infections that can cause PEM.
Low birth weight baby:-
During birth, baby’s weight is low, that can cause PEM.
Large family:-
If there are many children in large family it effects on nutrition because all children do not get food equally as quantitatively and qualitatively.
Stop breast feeding:-
If mother stops the breast feeding without giving proper weaning food it can cause PEM. Besides this if mother breastfeeds the babies for long time and does not give weaning food in right time it can cause PEM.
Frequent feeding:-
If mother births the baby frequently within 3 years, mother suffers from malnutrition.
Prevention of PEM:
Children should be given easily digestible food. At first high protein rich food is given in liquid form, then right amount of calorie and electrolyte should be given. The main objective is to increase the metabolic power and to build proper food storage system for growth and development of children.
Cow’s milk is an ideal as protein source. The children who cannot digest the cow’s milk, he or she should be given double toned milk. Wheat, pulses etc can be given but at first these will be roasted then these will be grounded. This mixture will be mixed with powder milk and then this can be served as in liquid form. Ripe banana can be mixed with milk to get calorie.
Fat can be given if children recover slightly.
Low cost nutritious food is very effective such as dahlia, khichdi, roti, fried Bengal gram, puffer rice. If diarrhea occurs, ORS (Oral Rehydration Solution) should be given.
Nutritional requirement:
Dietary management is very essential to prevent PEM. It is necessary to maintain balance of calorie and protein. Foods of vegetable origin are better than animal origin.
Energy-
The child should be given 150 – 200 kcal/kg body weight/day. Children who are less than 2 years 200 kcal/kg/body weight and for old children 150 -175 kcal/kg body weight should be given. Sugar and fat can provide these amounts of calorie. It is important to provide enough calories through diet because if there is observed the lack of calorie; protein is utilized for energy purpose. Then protein cannot work for tissue building.
Protein-
Protein should be provided 5gm/kg bodyweight/day. High biological value food should be given. Milk protein is good for health. Powder milk can be given because it is low cost food.
Fat:
Fat can be given which are tolerated by children. Saturated fat should be given such as butter, milk, coconut oil because unsaturated fatty acids worsen diarrhea.
Vitamins-
Usually vitamin A deficiency can be seen among kwashiorkor children. In severe case 50,000 I.U vitamin A oil is given through injection. In mild case 50,000 I.U vitamin A oil should be given. In case of severe malnutrition patient should be admitted to hospital for treatment. In mild case, treatment can be continued outside the hospital such as complications can be cured in primary health care or on an outpatient basis in a hospital.
To prevent anemia folic acid rich and iron rich food should be given or blood transfusion may be needed.
Dehydration:
Dehydration can be treated by Oral Rehydration Solution (Nacl 3.5 gm, NaHCo3 2.5 gm, Kcl 1.5 gm and glucose 20 gm dissolve in 1 liter of water) recommended by WHO. ORS is totally safe for patient. ORS should be given in small quantity at frequent intervals over a period 4 – 6 hours.
Malnutrition of children depends on his or her mother. So, mother should take care of children to prevent malnutrition.
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| Mother is feeding the baby |
- Mother should be given supplement food.
- Food should be enriched with iron, folic acid, iodine and other minerals.
- Tetanus should be taken.
- At first toxemia, anemia, sepsis and abortion should be prevented and child should be born safely.
Children (0 – 6 months)
- To reduce the birth rate of LBW (Low Birth Weight).
- Encourage the mother for breastfeeding.
- Give proper weaning food and supplementary food.
- Vitamin A and Iodine rich food should be given.
- To prevent diarrhea and infection Immunization scheduled should be followed.
Children (6 – 11 months)
- Educate about health.
- Personal care should be taken.
- To build good habit about food.
- Lunch should be taken in time.
- As soon as possible disease is treated.
- Regularly teeth, eye, skin should be examined.
Adolescence girl
- Anemia should be prevented
- Educate the girl about nutrition.
- They should not marriage under the age of 18 years.
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