Wasting affects 50.5 million children around the world every year. How does it differ from other forms of malnutrition? And how can we treat it? Click on the questions below to find out more.

What is malnutrition and what are the different forms of it?

Malnutrition is a serious condition where the body doesn’t get enough of the right nutrients to function properly. There are several types of malnutrition including:

  • Micronutrient deficiencies and deficiency diseases- when the body doesn’t get enough micronutrients such as iron or Vitamin A. This can cause a wide range of health implications.

  • Overweight/Obesity- being too heavy for a given height. Carrying extra fat leads to serious health consequences such as cardiovascular disease, type 2 diabetes, musculoskeletal disorders like osteoarthritis, and some cancers.

  • Stunting (chronic malnutrition)- being too short for a given age. This means that a child has not had the proper nutrition for a long period of time during a critical period of growth (the first thousand days). This affects both their physical and cognitive growth.
  • Wasting (acute malnutrition) - being too low weight for a given height. This means that a child has not received or been able to absorb the proper nutrition for an acute period of time, putting their body in extreme distress. Wasted children have an increased risk of death and can affect their health and development in later years.
  • Underweight - being under the normal weight for a given age

What is the difference between acute malnutrition and wasting?

Acute malnutrition is an umbrella term that includes wasting (being thinner than normal for your height measured either by weight for height or mid-upper arm circumference) and more complicated cases including bilateral pitting oedema, persistent diarrhea, high fever, severe dehydration, vomiting, no appetite, convulsions, oedema. Acute malnutrition can be moderate or severe.

What is the difference between stunting and wasting?

Stunting is a chronic form of malnutrition, that affects both physical and cognitive growth. Wasting is an acute, often short-term form of malnutrition that can be cured. A child can be both wasted and stunted, and children who simultaneously suffer from both these conditions are at a higher risk of death.

For more information on children who are wasted and stunted visit ENN’s WaST Project.

How do you measure if a child is wasted?

There are several ways of measuring if a child is wasted. The first is to measure their weight and height and compare it to a reference population.

The second is to use the Mid-Upper Arm Circumference (MUAC) is a quick and simple way to determine if a child has acute malnutrition. This MUAC measurement indicates if a child is acutely malnourished and in a state where their muscle tissues are breaking down. Using a MUAC tape a health worker or caregiver can measure the size of a child’s arm. MUAC tapes are colour coded: a red MUAC (a MUAC of < 115mm) means the child has SAM and an orange MUAC (MUAC between 115 and 125mm) means the child has moderate acute malnutrition, while a green MUAC (a MUAC> than 125mm) means the arm circumference is in the normal range.

What makes a child vulnerable to wasting? Can we stop it from happening in the first place?

There are several reasons a child could become malnourished, including one, or a combination of: diet (both the quantity AND quality of their food), or access to food, their health status and recent illnesses or care practices.

We can, and should continue to strive to find ways to prevent a child from becoming malnourished in the first place, from predicting periods in the year when food is likely to be scarce and infections more common, to interventions in care practices and agriculture. However, the causes are often varied and not always predictable, from disease outbreak to humanitarian conflict and we are still learning on how to best prevent wasting across these different contexts.

What is the dominant treatment available for wasting?

Moderate and severe acute malnutrition are currently treated separately, with different products and with different protocols.

Treatment of Severe Acute Malnutrition (SAM): Children with severe acute malnutrition (SAM) are in urgent need of treatment and in many cases, we cannot assume that they will recover without this life-saving treatment. Children with SAM without medical complications (persistent diarrhea, high fever, severe dehydration, vomiting, no appetite, convulsions, oedema), which make up the majority of SAM cases, can be treated with ready-to-use therapeutic foods (RUTFs), a nutrient and energy rich paste, in their own homes. This is a specific product that provides most of the calories needed by the child and has the right balance of protein, fat, carbohydrates and micronutrients that the child needs to recover. It is also already prepared so does not require the addition of water, which may not be available or safe for the child to drink. Only children with SAM and medical complications require treatment in hospitals or health centres, where they are treated with therapeutic milks and/or RUTFs.

Treatment of moderate acute malnutrition (MAM): Where supplementary feeding programmes are available, children with receive supplementary foods either in the form of ready-to–use supplementary foods (RUSFs) or fortified blended foods such as supercereal+. RUSFs, like RUTFs can be eaten straight from the packet, while fortified blended foods have to be cooked into a porridge before consumption. Supplementary foods are meant to be eaten by the child in addition (as a supplement) to home-based foods.

What is CMAM?

Community-based Management of Acute Malnutrition (CMAM) is an approach to diagnose and treat the majority of children with wasting in the communities. Previous to this approach treatment was only available through lengthy stays in hospital, due to the need for therapeutic milk to be kept in cold temperatures. This meant parents and their children could face long distances to travel to the nearest hospital, and a loss of income while their child was treated.

According to this model, children with SAM without medical complications can be treated with RUTFs in their own home, with regular visits to a local health facility, where their progress is monitored, and they receive routine medical care and rations of RUTF to take home. Only children with SAM with medical complications need to be referred to hospitals for inpatient care. Where available, children with MAM receive supplementary foods at supplementary feeding programmes. The CMAM approach is now the leading approach for the treatment of acute malnutrition and is implemented in over 70 countries around the world.

What does the prevalence (7.5%) of wasting tell us?

Every year, the prevalence of wasting is reported globally. In 2017, 7.5% of all children globally, or 50.5 million children, suffered from wasting.

However, in reality we believe that many more children truly suffer from acute malnutrition. This is because:

  1. A child can have multiple cases of wasting in a single year. This prevalence measure only captures the total children who have wasting at one point in time. In reality, those children (and new children) could have multiple cases of wasting later in the year;

  2. This number does not include children who have acute malnutrition with bilateral oedema or who would be diagnosed as having acute malnutrition based on low MUAC.

Why should wasting be a development priority?

Undernutrition serves as the underlying cause of almost 50 percent of child deaths. Children threatened and affected by wasting are at a disadvantage- they are up to 11 times more likely to die than well-nourished children. Malnutrition can also have long term implications on physical and mental development and the productivity of individuals and societies.

The scale-up of SAM treatment would result in at least $25 billion in increases in economic productivity over the productive lifetimes of children who benefited from the program. Each dollar invested in treatment would result in at least $4 in economic returns. Failure to prevent and treat malnutrition at scale undermines the effectiveness of efforts to progress on all Sustainable Development Goals.

What is needed to help turn the tide?

Making nutrition specific and nutrition sensitive programming a health and development priority is essential to improve prospects for the 50.5 million children with this disease. We must invest in the people, systems and services that can reduce the cost and increase the number of children reached with prevention and treatment services. With the support of civil society organisations, donors and foundations, companies, academic and research institutions, governments and individuals from all backgrounds, we can together accelerate action for children with this deadly disease.

Who should provide funding for wasting prevention and treatment?

Long-term sustainable financing, in addition to humanitarian response funding, is needed to make a meaningful difference for children with wasting. A concerted effort is needed from both national governments and donors in order to meet World Bank projections of a necessary $2.6 billion per year to scale up community-based treatment of severe acute malnutrition, and an additional $3.6 billion to scale up complementary feeding to prevent and treat the moderate form of this disease. For more information about progress in nutrition investment, review R4D’s report ‘Tracking aid for the WHA nutrition targets’.

Need more information about acute malnutrition? Visit ‘The Facts’ page for more wasting data and sources.