Médecins Sans Frontières (MSF) has been treating acute malnutrition since our founders first responded in Biafra in southern Nigeria in 1971.
In 2022, more than 30 million children suffered from acute malnutrition in the 15 worst-affected countries, as reported by the WHO (World Health Organization). An estimated eight million of these children were severely acutely malnourished, and at greatest risk of dying.
Malnutrition is caused by an imbalance between the nutrients the body receives and the nutrients the body needs. Malnutrition disrupts a person’s optimal growth, development and wellbeing, and can have long-lasting if not fatal consequences. It affects people of all ages around the world.
Undernutrition is one of three forms of malnutrition. It is the underlying cause in approximately 45 per cent of deaths among children under five years of age, according to the WHO.
MSF focuses on acute malnutrition, an undernutrition category especially related to a higher, short-term risk of death in children. Acutely malnourished children are recognised by their severe or recent loss of muscle and fat—wasting—and/or swelling due to fluid retention (oedema) and other symptoms collectively known as kwashiorkor.
Pregnant and lactating women, the elderly, and people of any age who are severely sick or have a chronic disease also have a higher risk of acute malnutrition than the general population.
The problem is often not just a lack of food. Nutrients are key, and not all food sources provide the essential nutrients for optimal health. Communities, families and caregivers can struggle to meet their children’s very important nutritional needs due to a range of factors.
People may have difficulty obtaining nutritious food due to cost-of-living pressures or shortages in food supply due to seasonal factors such as harvest gaps. These may be interlinked with disruption caused by conflict, disaster and climatic changes—or multiple causes at once.
Khaista Gul brought his two-year-old malnourished grandson, Mustafa, for a medical consultation in MSF’s therapeutic feeding program in Kandahar, Afghanistan. © Tasal Khogyani/MSF
Healthcare plays an important role in preventing acute malnutrition. Without reliable healthcare to intervene, disease and malnutrition can interact to create a vicious, life-threatening cycle. This is especially the case in children, whose weakened immune system due to acute malnutrition makes them more vulnerable to other diseases such as measles and pneumonia, and vice-versa.
It is factors like these that have contributed to the alarming levels of malnutrition that MSF has seen in recent years in countries including Nigeria, Ethiopia, Kenya, Afghanistan, Chad and Yemen.
The mid-upper arm circumference (MUAC) band has been pivotal to diagnosing acute malnutrition. A colour-coded measuring tape, it is wrapped around an individual’s left upper arm to measure the degree of muscle wasting. A circumference of less than 115mm indicates severe acute malnutrition (SAM) and significant risk of death in children under five years.
Pregnant and lactating women, the elderly, and people of any age who are severely sick or have a chronic disease also have a higher risk of acute malnutrition than the general population.
In a hospital or health centre SAM and moderate acute malnutrition are diagnosed in cross-reference with other measurements and indicators, but the MUAC band’s portability and ease of use has allowed a simplified diagnosis combining MUAC measurement and checking for oedema. This simplification is often used in emergency contexts, or by community health workers and even family caregivers to detect wasting and the early stages of kwashiorkor in children without also needing to measure weight and height.
For children under five, MSF establishes therapeutic feeding programs (TFP) to reduce deaths and treat acute malnutrition by providing adapted medical and nutritional care. There are two, linked services in a TFP: outpatient care in what is known as the ambulatory (walk-in) therapeutic feeding centre, or ATFC, and inpatient care in the inpatient therapeutic feeding centre, or ITFC.
In the ATFC we can successfully treat acutely malnourished children who do not have severe medical complications, as well as children who have recovered in the ITFC but must stay in the feeding program as outpatients until they are fully cured.
In the ITFC, we treat children who are severely malnourished but also facing severe medical complication(s) in intensive care first, before they enter the first phase of their therapeutic feeding. We start children’s nutritional rehabilitation with specially formulated milks then progress to Ready-to-use therapeutic food (RUTF). Children will typically stay in the ITFC for five to seven days.
RUTF has been revolutionary in enabling us to effectively treat acute malnutrition. RUTF contains a specific balance of nutrients in paste, like peanut butter, or biscuit form, and is designed to be stored long-term without refrigeration which allows the majority of children to continue treatment in the care of their family, supported by their regular follow-up appointments at the ATFC.
Children can be fully cured in approximately six weeks.
As part of the full package of care, MSF provides antibiotics to fight infection, and catch-up vaccinations to ensure nutrition patients are protected against other illnesses. We also provide psychosocial support and stimulation for young patients and their caregiver/s, to help the children and their relationships thrive.
