Causes of Malnutrition among Children

a) Diseases
i.
HIV/AIDS
HIV, immune system and nutrition status are complex and closely linked to each other
(Duggal, Chugh & Duggal, 2012). They interact in a way that can increase the vulnerability
in each condition. In other words, HIV infection can cause a malnutrition, while poor diet can
speed up HIV infection process. Acquired immune deciency syndrome, or AIDS, is a
disease caused by a retrovirus, the human immunodeciency virus (HIV), which attacks and
impairs bodys natural defense system against disease and infection. (Duggal et al., 2012).
According to (Lange, 2010), there are 800 000 children becoming newly infected of
HIV and AIDS yearly and 500 000 dying from AIDS related illnesses each year and to sum up
there are three million children have HIV and AIDS. HIV/AIDS contribute to malnutrition by
alterations in metabolic activities and infection in which by altering the metabolism of energy,
carbohydrates, fats, proteins, vitamins, and minerals (Garcia-Prats, McMeans, Ferry & Klish,
2003). Children with HIV and AIDS show an immediate effect of the insufficient food intake and
infection.
HIV also decreases nutrients absorption and the use of nutrients from the food eaten and
increases the bodys normal energy requirements by 10-30% in adults and 50-100% in children
(Pridmore & Hill, 2009). Fever among HIV patients also believed can increase the utilization of
protein as well as calorie (Garcia-Prats et. al., 2003). Duggal et. al., (2012) claimed that HIVinfected children also can have malnutrition due to reduced appetite. Reduced appetite may be
because of reduced oral intake and gastrointestinal tract infection. Depression, medications,
nausea, fever can be contributing factors to the reduced oral intake (Winter, 1996). The difficulty
for children to take in food because oral thrush infections also can reduce their appetite thus lead
to malnutrition among children (Duggal et. al.,2012). When gastrointestinal tract interact with
HIV, it can affect ones nutritional status as diarrhea and vomiting (Garcia-Prats et al., 2003).
ii.

Diarrhea
Diarrhea is among the primary cause of malnutrition in children under five years old

(Who.int, 2015). Diarrhea is defined by WHO as the passage of loose or liquid stools more

frequently than normal for an individual (Who.int, 2015). Basically diarrhea often occur for
prolonged period alongside with more severe condition lead to high case of death (Reddy, 1985).
Most death cases due to diarrhea occurs in less developed countries and the malnourished
children recorded the highest rates of diarrhea cases (Baqui, 2006). Diarrheal disorder can come
in two types which are acute and persistent diarrhea (Thapar & Sanderson, 2004). Pathogen
infection cause prolonged period of diarrhea to a child make the child more vulnerable to
develop persistent diarrhea (Ochoa, Salazar-Lindo & Cleary, 2004).
Diarrhea usually caused by gastrointestinal infection by bacteria, viruses or parasites in
the intestines (Who.int, 2015). Salmonella spp and Shigella spp are factors that causes acute
bloody diarrhea (dysentery) and recorded 15% of all fatal cases due to diarrhea in children
(Thapar & Sanderson, 2004). Shigella bacteria are resistant to low pH, and a few thousand
organisms suffice, which are readily transferred by direct person-to-person contact or through
contamination of inanimate objects, such as a cup (Keusch et al., 2006). Mortality cases
worldwide recorded 600 000 fatality among children below five every year due to Shigella
infection (Kotloff et al., 1999). On the other hand, Vibreo Cholerae needs millions of bacteria
thus require to multiply first to cause an infection (Keusch et al., 2006).
Diarrhea alters nutritional status in several ways including reduced food intake,
malabsorption of nutrients and metabolic losses (Reddy, 1985). The reduction of food intake
while suffer from diarrhea is because of anorexia along with dehydration and electrolyte
imbalance (Reddy, 1985). Diarrhea occurs when there is imbalance in electrolyte and water
transport in which there is decreased absorption from the intestinal lumen or increased secretion
or water loss into the lumen (Thapar & Sanderson, 2004). Dehydration also is the most direct
consequence of diarrhea, recorded the majority of death cases (Baqui, 2006). Dehydration from
diarrhea leads to an acute loss of weight from water loss and can be life-threatening (GarciaPrats, et al., 2003). Diarrhea lowered the oral intake due to calorie requirements that increased
(Garcia-Prats et al., 2003).
iii.

Measles
Measles is one of the viral infection that attack 95% of children below 5 years and

account for significantly high cases of morbidity and mortality in developing countries
(Bhaskaram, 1992). This can be because children below 5 years has lower immune system

compared to other age categories. Symptoms of high fever, malaise, cough, coryza, conjunctivitis
followed by maculopapular rash are characters to describe measles (Kutty, Rota, Bellini, Redd,
Barskey & Wallace, 2013). On the other hand, lack of vitamin A can lead to measles associated
with blindness (Bhaskaram, 1992).
Measles is caused by a virus of paramyxovirus family, Morbillivirus

(Kutty, Rota,

Bellini, Redd, Barskey & Wallace, 2013). It is transmitted via droplets from the nose, mouth or
throat of infected persons (Who.int, 2015). Airborne transmission can occur via aerosolized
droplet nuclei as it has been authenticated in a closed area once a measles person occupied the
area for up to 2 hours (Wallace, Leroy & Wolfe, 2015). Most cases of measles occurred among
children start with mild fever, cough, runny nose, red eyes and sore throat. Following the
symptoms, red rash appears after few days. There may be present of Kopliks Spot (Measles,
2015). As Morbillivirus can transmit from person-to-person via airborne droplets, therefore
coughing and sneezing can easily spread the virus. Exposure to heat, sunlight, acidic pH, ether
and trypsin can cause Morbillivirus to be inactivated rapidly (Wallace, Leroy & Wolfe, 2015).
According to Scrimshaw, Taylor & Gordon (1968) suggested that malnutrition and
infection has a synergistic relationship. Infection can cause a child to become malnourished
while malnutrition can make a child more vulnerable to infection (Figure 1). The mechanism on
how measles contributes to malnutrition is more complicated that the general mechanisms
(Bhaskaram, 1992). Measles infection influences the amount and type of food consumed
(Scrimshaw, Taylor & Gordon, 1968). It can leads to severe reduction in food intake besides
causing vomiting and increased metabolic losses (Bhaskaram, 1992). Having measles causes
them to loss appetite, loss of nutrients and malabsorption (Katona & Katona-Apte, 2008). This
can lead to significant loss of body weight recorded (Bhaskaram, 1992). This situation followed
by growth retardation 6 months after measles (Bhaskaram, 1992). Besides that, measles can lead
to lack of important nutrients such as vitamin A. Vitamin A deficiency impairs immune function
(Stephensen, 2001). There is reduction in circulating T cell number and impaired proliferation
of T lymphocytes was demonstrated in children during the episode of measles (Bhaskaram,
1992).

Figure 1: interaction between infection and malnutirition