⚠️ Men's Health

Kwashiorkor & Marasmus: Severe Malnutrition

Q: Is kwashiorkor caused only by protein deficiency?

It is primarily caused by protein deficiency and overall nutrient insufficiency. Modern evidence also implicates gut bacteria changes and aflatoxin exposure (from mouldy grains) in kwashiorkor development.

Q: Where is RUTF available in Nigeria?

RUTF (Plumpy'Nut sachets) is distributed free through UNICEF-supported Outpatient Therapeutic Programmes (OTPs) at primary health centres in most states. Ask at your nearest health centre.

Q: Can SAM children be treated at home?

Uncomplicated SAM (good appetite, no medical danger signs) is treated successfully at home with weekly RUTF supply and clinic follow-up. Complicated SAM requires hospital stabilisation first.

Q: Why are SAM children given special milk — not normal food?

In phase 1, normal food can worsen electrolyte imbalances and cause heart failure in severely malnourished children. F-75 is specially formulated with the right balance of nutrients for safe stabilisation.

Q: How long does treatment take?

Hospital stabilisation takes 1–2 weeks. RUTF outpatient rehabilitation takes 6–8 weeks. Total recovery to normal growth can take 4–6 months.

Recognising and treating severe acute malnutrition in Nigerian children

Severe acute malnutrition (SAM) kills more than 450,000 Nigerian children under five annually — making Nigeria one of the countries most affected globally. SAM presents as either kwashiorkor (protein deficiency with oedema), marasmus (severe wasting with no oedema), or marasmic-kwashiorkor (both). SAM is preventable and treatable — but requires prompt recognition, referral, and appropriate nutritional rehabilitation.

Signs and Symptoms

✓ Kwashiorkor: swollen feet and legs (pitting oedema), pot belly, hair discolouration (reddish or grey), skin peeling, miserable and apathetic

✓ Marasmus: severe wasting — can see ribs, shoulder blades, and hip bones; 'old man face'; folds of loose skin; alert and hungry despite extreme thinness

✓ Both: MUAC <11.5cm, weight-for-height Z-score <-3, or bilateral pitting oedema (even with normal weight = SAM)

✓ Complications: hypoglycaemia, hypothermia, severe infection — any of these = immediate hospital admission

Risk Factors

Poverty and food insecurity
Early cessation of breastfeeding and poor complementary feeding
Repeated infections (malaria, diarrhoea, pneumonia) depleting nutritional reserves
Large family size with inadequate food sharing
Maternal malnutrition during pregnancy and lactation
Displacement, conflict, or flooding destroying food supplies

When to Seek Help

Emergency hospitalisationAny child with SAM AND: bilateral oedema Grade 3 (up to groin/arms), any of the 'danger signs' (hypoglycaemia, severe dehydration, shock, altered consciousness, severe respiratory distress, high fever)

Community therapeutic care (CTC)Uncomplicated SAM (no medical complications) can be managed at home with Ready-to-Use Therapeutic Food (RUTF) and weekly clinic visits

ImmediatelyAny child with MUAC <11.5cm or visible severe wasting should be seen by a health worker the same day

Tests & Diagnosis

🧪 MUAC measurement

Mid-upper arm circumference: <11.5cm = severe acute malnutrition; 11.5–12.5cm = moderate acute malnutrition

🧪 Bilateral pitting oedema check

Press thumbs on tops of both feet for 3 seconds — if pitting (indentation) remains = kwashiorkor, classify as SAM regardless of weight

🧪 Blood glucose

All SAM children should have blood glucose checked: <3.0 mmol/L = hypoglycaemia, treat immediately with oral/IV glucose

🧪 Rapid malaria test (RDT)

Malaria commonly precipitates SAM decompensation; treat if positive

🧪 Weight and height/length

Plot on WHO growth charts; weight-for-height Z-score <-3 = SAM

Treatment Options

Phase 1: Stabilisation (first 1–7 days in hospital)

F-75 therapeutic milk — low protein formula to restore metabolism; treat infections, hypoglycaemia, hypothermia, and electrolyte imbalances; do NOT use standard high-protein milk

Transition phase (days 3–7)

Gradual switch from F-75 to F-100 as oedema resolves and appetite returns

Phase 2: Rehabilitation (weeks 2–6)

F-100 therapeutic milk or RUTF (Plumpy'Nut) — high protein/calorie diet for rapid catch-up growth; may continue as outpatient

RUTF (Ready-to-Use Therapeutic Food)

Peanut-based paste with added vitamins and minerals — provided free by UNICEF/government at CTC centres; given to child to eat directly from sachet

Micronutrient supplementation

Vitamin A (if deficient), zinc, folate — given as part of standard SAM protocol

Follow-up

Weekly MUAC monitoring; immunisations once stabilised; family counselling on nutrition and feeding practices

Frequently Asked Questions

Is kwashiorkor caused only by protein deficiency?

It is primarily caused by protein deficiency and overall nutrient insufficiency. Modern evidence also implicates gut bacteria changes and aflatoxin exposure (from mouldy grains) in kwashiorkor development.

Where is RUTF available in Nigeria?

RUTF (Plumpy'Nut sachets) is distributed free through UNICEF-supported Outpatient Therapeutic Programmes (OTPs) at primary health centres in most states. Ask at your nearest health centre.

Can SAM children be treated at home?