Risk factors for severe malnutrition

1. Parental factors
 Maternal age, young parents especially less than 25 years of age
 Marital status (single versus union)
 Unemployment of either the mother or the father
 Low level education
 Orphaned or deserted
 Drugs and alcoholism
 Working mother with inadequate child minding
2. Dietary and socioeconomic factors
 Large family size (more than 4 children)
 Poor birth spacing
 More than 2 children under 5 years old
 Introduction of complementary feeding at less than 6 months of age
 Breastfeeding cessation before 6 months of age
 Lack of breastfeeding
 Less than 3 daily meals
 No clean water sources
 Lack of preschool consultation
3. Child factors
 Prematurity
 Low birth weight (contributed to by maternal malnutrition)
 Recurrent or chronic diarrhoea (vicious cycle with malnutrition), pneumonia, TB
(decreased appetite, decreased absorption of nutrients)
 Comorbidities such as cancer and other chronic diseases, also cerebral palsy (difficulty
feeding when pharyngeal muscles are affected)
 Twins, triplets
 HIV infection
4. Others
 Family history of malnutrition
 Family affected by HIV

Interventions that can be instituted at the district to reduce malnutrition

1. Education
 Primary healthcare centers
 Antenatal and postnatal visits
 Anyone attending for any reason
 Growth monitoring and promotion visits
 Vaccination and immunisation visits
 BF practices (introduction of complementary feeds, BF cessation, storage of
breast milk for working mothers, adequacy of feeding)
  Importance of at least 3 balanced meals a day
 Preparation of balanced meals using locally available and accessible foods
(maize, peanuts, vegetables, beans)
 Interactive sessions with health care attendees to ensure understanding and
address questions
 Importance of growth monitoring, antenatal care, postnatal care and
vaccinations
 Advantages of combating malnutrition (less diseases, reduced mortality and
morbidity, immunity boost, school performance and work productivity,
cognitive and socioemotional development, increased adult stature
 Importance of maternal nutrition to ensure child nutrition
 Family planning and birth spacing
 Supplementation programs for children and infants, pregnant mothers and girls
 Community-based education
 At gatherings, including men
 At schools especially young girls
 Engagement of men in these programmes

2. Supplementary feeding programs

a. Importance of community engagement to sustain programs
 Gardening, chicken rearing…
 Community participation of mothers and volunteers preparing meals, men
serving…
 Promotion of local food-based meals and supplementary feeding rather than
foreign foods (those brought in by NGOs)
b. Engage NGOs and MOH for support
 Reiterate importance of using locally available foods (beans, peanuts, maize,
vegetables)
c. Micronutrient programs
 Iron, folate, vitamin A, Zinc, Iodine, vitamin D as appropriate to pregnant
women, girls, children and infants
 Decentralisation of supplementation programs as well as vaccination
programmes
 Strengthen vaccination programmes such as measles (depletes vitamin A)
 Multiple micronutrients for home fortification of foods for children and
pregnant women
 Supplementation in pregnancy and managing appropriate gestational weight
gain

3. Growth monitoring and promotion

 Primary health care centers and community based
  Use of volunteer parents and community health workers under supervision of nearest
health care center
 Early identification of children at risk and early malnutrition to administer interventions
early
 Empower parents to recognize growth patterns and seek help
 Reiterate the importance of growth monitoring and the incentives such as free health
care for all under 5 children who attend
 Community based programmes for growth monitoring and awareness, including schools
and gatherings
 Early referral of malnourished children
4. LBW children
 Breastfeeding practices
 Cup feeding in those unable to feed
 Education of all moms including in antenatal care to prepare for such instances
 Kangaroo units to teach moms care of LBW babies
 Micronutrient supplementation
 After discharge care education
5. Others
 Water and sanitation programmes
 Education of community members on the importance of clean water supply and its role
in malnutrition
 Classroom education for young girls and boys above maternal nutrition, intrahousehold
food allocation which prioritizes children and pregnant women in preparation for
adulthood
 Care, education and support for young mothers
 Strengthening PMTCT programs to prevent HIV infection in children