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Guidelines for severe malnutrition: back to basics
  1. Raphael S Oruamabo
  1. Correspondence to:
    Professor R S Oruamabo
    Department of Paediatrics and Child Health, College of Health Sciences, University of Port Harcourt, PO Box 126, Choba, Port Harcourt, Nigeria; raphael_oruamabo{at}

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Perspective on the paper by Karaolis et al (see page 198)

Malnutrition is a global problem that varies from undernutrition to overnutrition, but this article is confined to undernutrition. It has been defined as failure of the body to obtain the appropriate amounts of protein, energy, vitamins and other nutrients it needs to maintain healthy tissues and organ function. Worldwide, the most common form of malnutrition is iron deficiency, which affects about 80% of the world’s population. Protein-energy malnutrition affects about 20% of the world’s population and is most common in the developing countries of Asia and Africa. Although malnutrition occurs globally, with an estimated 26% of under-fives being moderately and severely underweight, 10% each being severely underweight or wasted, and 31% being moderately and severely stunted, the developing and resource-limited settings are most affected.1 Various forms of malnutrition have been contributory to increased morbidity and mortality of under-fives in developing countries. Unfortunately, despite different intervention strategies, malnutrition, which was a contributing factor to 55% of under-five deaths in developing countries in the 1990s, is now estimated to contribute to about 60% of such deaths.2


In Nigeria, with an estimated population of 140 million inhabitants and an under-five population of approximately 28 million, between 1996 and 2004, the percentages of under-fives with severe underweight, moderate to severe wasting, and moderate to severe stunting were 9, 9 and 38, respectively.3 However, a more detailed analysis showed that children resident …

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  • Competing interests: None declared.

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