In a world filled with beautiful dreams of possibilities, severe undernutrition is still a reality. The battle against hunger and malnutrition is still unfolding. The question is, ‘How do we prevent this silent, but dangerous crisis?’ Read on to know how.

Introduction

Definition of marasmus

Marasmus is a severe form of acute malnutrition resulting from macronutrient deficiency.¹ It is centred more on calories and protein-energy undernutrition. It is most common when the body's fats get used up and the amount of nutrients the body gets in replenishment is not commensurate with what the body has used, thereby leading to starvation. The patient’s physically starved appearance makes it easy to detect marasmus.

Marasmus is most prevalent in children under 1 year. This is because the burden is more visible in children’s developmental and growth states, usually during their first years of life. Notwithstanding, people in other age brackets especially the elderly ones can be affected. It is mostly caused by the discontinuation of lactation and substitution with baby formulas which are poor in calories. It is common in developing, and low and middle-income countries (LMIC)

In this article, our focus will be on ways to avert marasmus.¹

Overview of prevention

Prevention is always better than cure. Marasmus when not prevented at the early stage can lead to severe health complications, which can lead to death. Therefore, disease prevention approaches are vital to break the cycle of malnutrition. 

Maternal and child health

Prenatal care: Pregnant women should have a healthy diet as this affects the foetus's growth and development, thereby resulting in low birth weight and other pregnancy complications. Care should be taken by pregnant women to prevent excessive intake of calories as this can lead to gestational diabetes. Diet deficient in macronutrients like carbohydrates, proteins, fats, etc., should be avoided during pregnancy as this can lead to pregnancy disorders and foetal growth restriction.²

Postnatal care: it is advised that lactating mothers exclusively breastfeed their babies for at least 6 months without the introduction of formulated foods or solid foods. And continue after 6 months with a slow introduction of complementary breast milk. Breastfeeding mothers should eat food rich in macronutrients for their healthy well-being and that of their children.²

Education and awareness

Pregnant women and children’s caregivers should be well enlightened on the importance and advantage of exclusive breastfeeding, the time to start weaning, and the dangers of childhood malnutrition. Emphasis should be placed on the need to put the knowledge into practice, as most caregivers are aware of the need and importance of exclusively breastfeeding their babies, but do not take actionable steps. Mothers and expecting mothers should be assessed on their knowledge of child nutrition during their postnatal and prenatal appointments at the hospital.³

Furthermore, the community should be educated on marasmus and other types of malnutrition (kwashiokor and marasmic kwashiokor), its signs and symptoms, treatment, and management. This will go along in the prevention of severe malnutrition.

Care for older populations

Marasmus also leads to morbidity and mortality of the elderly ones living amongst us. As they grow older, there is a reduction in physiological function and increased anorexia that hurts their nutritional status.⁴ It is imperative to take adequate care of them, providing them with the daily recommended amount of macronutrients their body requires for proper functioning.

Growth monitoring

Monitoring children's growth and development helps detect when there is a danger of malnutrition and maintain healthy height and growth. The weight and height of one child differ from the other. Nevertheless, the rate at which a child grows tracks a regular sequence. Weight and height checks should be done at intervals to inform if the baby is losing or gaining weight. A good sign of a child growing well is a healthy weight gain, while a sign that the child is not growing well is the loss of weight.⁵ Parents and caregivers should attend growth monitoring sessions, this will help to prevent or detect marasmus at an early stage.

Sanitation and hygiene

Maintaining proper Water, sanitization, and Hygiene (WASH) techniques around the home and community helps to prevent the risk of infections associated with marasmus and this has a good effect on child nutrition.⁶ Adequate water, sanitization, and hygiene techniques improve the quality of life and reduce poverty, which is one of the leading causes of marasmus.

How about government policies? 

Government should implement actionable interventions, especially in developing countries where severe malnutrition is most common. Committees for the WHO Sustainable Development Goals (SDG 2) should be set up to help develop strategies for preventing and alleviating the menace of severe malnutrition especially among children, pregnant and lactating mothers, and the elderly.⁷

Advocacy groups

There is a need for advocacy groups like international and local NGOs, stakeholders, and civil societies, etc., to put more effort into the battle against severe malnutrition. These groups should advocate for the proper allocation of resources that will impact the strategies that prevent marasmus. Bringing the communities most affected by hunger to the frontline and sharing their stories will go a long way in preventing marasmus.⁸

Control of infectious diseases

Diarrhoea and other infectious diseases harm the linear growth of children. Diarrhoea, one of the causes of marasmus, accounts for 10-80% of growth impediments in children during their first year of life.⁹ Control of these diseases will help to prevent marasmus and its complications.

Summary

Marasmus, one of the leading causes of child morbidity and mortality can be averted before its threats eat deep into the fabric of our society. It is common in children under 1 year, who are breastfeeding, children under 5 years, and older populations, who suffer from hunger. Through proper education of pregnant women, lactating mothers, and the community at large. The wash, sanitation, and hygiene techniques help to prevent infectious diseases related to marasmus. Government is encouraged to set up more policies in the achievement of the SDG2. The growth of children within the first year of birth should be properly monitored. Adequate care should be given to the elderly, ensuring they have a good diet containing their macronutrient needs. If all these measures are taken, marasmus is sure to be prevented.

FAQs

What is the difference between marasmus and kwashiorkor? 

Kwashiorkor is a condition caused by severe protein-energy undernutrition which is characterized by emaciated limbs, swollen face, hands, feet, and belly. People with kwashiorkor are deprived of only protein-rich food but not calories. Marasmus on the other hand is a severe form of undernutrition by a deficiency in all forms of macronutrients which include calories, proteins, and fats.

What are the causes of marasmus?

Marasmus can be caused by factors like:

• Hunger and food scarcity
• Diarrhoea
• Wasting diseases like AIDs
• Child abuse
• Inappropriate breastfeeding
• Anorexia nervosa
• Inability to absorb food
• Maternal undernutrition
• Maternal anemia

What are the symptoms of marasmus?

The symptoms of marasmus are:

• Fat and muscle wasting
• Severe weight loss
• Stunted linear growth in children
• Larger head than the body
• Low Body Mass Index (BMI)
• Weakness and dehydration 
• Skin atrophy
• Hair loss
• Fatigue

What are the complications of marasmus?

• Compromised immune system
• Impaired cognitive development
• Gastrointestinal malabsorption
• Refeeding syndrome
• Unconsciousness and coma
• Cardiac complications

How can marasmus be treated?

The treatment measures for marasmus is divided into 3 phases:

• Rehydration and stabilisation: Diarrhoea being one of the symptoms of marasmus leads to loss of electrolytes. Oral rehydration solutions (ORS) are administered to replenish the lost electrolytes
• Nutritional intervention: Here a Ready-to-Use Therapeutic foods (RUTF) are formulated and administered to the patient. The advantage of this intervention is administration to outpatient, thereby avoiding the opportunity cost associated with going to the clinic
• Follow-up and prevention of occurrence: Patients treated for severe malnutrition are followed up and monitored by the healthcare provider to prevent reoccurrence

What are the other types of malnutrition?

Other types of malnutrition are:

• Kwashiorkor
• Marasmic kwashiokor

What is the difference between marasmic kwashiokor and kwashiokor?

Kwashiokor is a severe form of malnutrition caused by protein-energy undernutrition. It is characterised by emaciated limbs, swollen stomach, feet, hand, and face. Marasmic kwashiokor is a combination of marasmus and kwashiokor.