Both the number of people affected by malnutrition and highest prevalence of wasting occur in lower-middle-income countries

Aetiology

• Lack of access
• Poor feeding practices
• Infection

Clinical features

Kwashiorkor - protein energy malnutrition from only having carbs resulting in oedema

Marasmus - characterized by energy deficiency resulting in low body weight

Investigations

Diagnosis of severe acute malnutrition (kwashiorkor or marasmus)

• Mid-arm circumference <115mm
• Weight for height under 3SD
• Oedema of both feet

Management

Criteria for inpatient or outpatient care

• Children who are identified as having severe acute malnutrition should first be assessed with a full clinical examination to confirm whether they have medical complications and whether they have an appetite
• Children who have appetite and are clinically well and alert should be treated as outpatients
  • Investigate cause
  • Vitamin A
  • De-worm
  • Ready to use therapeutic food (RUTF) - peanut butter, dried milk, vitamins and minerals
  • Check vaccinations
• Children who have medical complications, severe oedema, or poor appetite or present with one or more danger signs should be treated as inpatients (as below)

Inpatient management

• Management is the same for kwashiorkor and marasmus