Definition
Marasmus can be defined as malnutrition that develops to severe levels. As a result, the disease leads to the wasting away of body fats. Body muscles also waste away due to underfeeding of the victim. Malnutrition develops because the victims’ body is not supplied with adequate calories and proteins. Undernourishment that culminates in marasmus can result from complete starvation where patients have a complete lack of food. In addition, marasmus can result from the inadequate supply of vitamins in the body. The disease has been rated as one of the major malnutrition illnesses in the world. In fact, it has been ranked as one of the fatal protein-energy deficiency illnesses. The condition is very prevalent in children, especially in third-world nations. For example, it is common in Latin America, South Asia, and Africa. All these regions face poverty, unclean water, and lack of enough food. In fact, some areas suffer from a complete lack of food hence starvation that is associated with the disease under scrutiny.
Causes of Marasmus
The major cause of marasmus is the deficiency in energy supplies in the body. When the body is supplied with low calories and proteins, it is deprived of its energy reserves. This inadequate supply of proteins and calories is common in developing nations. Such deprivations are associated with poverty. It is out of poverty that people lack adequate supplies of food and clean water. Children born and living in poverty-stricken areas are the most affected by marasmus. For example, marasmus prevalence is higher in Africa, South Asia, and Latin America compared to other parts of the world. Such continents suffer from low food sources and supplies. Most of their people come from very poor backgrounds. They hardly provide for themselves. Unfortunately, marasmus also affects quite a considerable number of children in developed nations.
Various factors predispose people to marasmus. Out of these risk factors, most people become victims of marasmus. However, not everyone who is exposed to these predisposing factors ends up being a marasmus victim. One of the major causes of marasmus in chronic hunger. When the body lacks a supply of various nutrients, it becomes generally weak and malformed. The normal metabolic processes are halted. During this time, the victim becomes feeble. A prolonged inadequate supply of proteins and calories to the body will also result in marasmus. Feeding on very little food that cannot sustain the normal body processes and body reserves may finally lead to the development of marasmus. Persistent food shortage deprives the victim’s body of the normal body ration. In fact, inadequate food supplies constitute the major cause of marasmus since food is the major source of energy for the body. For the body to sustain its processes, it requires energy. Vigor comes from the food that an organism uses. It is therefore advisable to provide the body with enough food to curb the occurrence of the disease.
Another cause of marasmus is a deficiency in various vitamins. For example, if the body does not get supplies of vitamin A, K, and E, the victim will suffer from malnutrition. The human body requires a variety of vitamins for proper functioning. Lack or low supply of one of these vitamins may result in marasmus. The ability of the body to defend itself will also highly depend on the amount of vitamins supplied to it. The body is therefore predisposed to various attacks. Such attacks from pathogens and other disease-causing organisms only serve to make the fragile body weaker.
Consumption of an unbalanced diet is another cause of marasmus. For example, food that is lacking in components such as vegetables, grains, fruits, proteins, and/or carbohydrates may result in marasmus. The body requires an adequate supply of all nutrients for it to function well. When a child is fed on food that lacks one of the major sources of a particular nutrient, he or she is likely to suffer from marasmus. The body will become generally weak and unable to withstand the attacks and invasion by pathogens. Every nutrient is crucial in the body. It is also important to realize that every nutrient plays a certain crucial role in body developmental process.
Consumption of contaminated water is another risk factor that predisposes people to marasmus. Unfortunately, most of the people who suffer from marasmus in developing nations lack clean water supplies. Water is crucial for purposes of ensuring proper functioning of body processes. Every metabolic process in the body requires water. Lack of water or insufficient supplies of it may lead to marasmus.
Epidemiology
The frequency of cases of marasmus in the United States is very low since the federation is able to provide adequate food for its citizens. However, there have been reports of marasmus in the previous years. For example, in the year 1995, marasmus was attributed to 228 deaths that occurred in the US. During this period, elderly people made up the larger percentage of people dying out of marasmus. For example, in 1995 only three children died out of marasmus. The rest of the deaths comprised the elderly. However, most of the patients who are diagnosed with marasmus in United States have another condition that predisposes them to it. Prevalence of marasmus in the US in severe rates is only 1.3 percent. Moderate rates are at 5.8 percent while mild cases are 17.4 percent. In addition, a study that was conducted in Michigan indicated that the prevalence was higher among children who were hospitalized because of heart diseases. For instance, 33% of them suffered from chronic marasmus levels while 64% of them suffered from mild marasmus levels. These levels were clear especially when researchers compared height and weight and related it to malnutrition. Children who are chronically ill in the United States have the highest levels of marasmus. Perhaps the high level of prevalence can be attributed to their inability to feed well rather than food deprivation resulting from their providers.
Marasmus is a condition that is widely spread in the world. At least 30% of all human beings suffer from different forms of malnutrition. It is also clear that about 50 million young children across the world today experience PEM. In most cases, such children are below five years of age. Moreover, 50% of children who pass on before their fifth birthday are likely to be malnourished. As posed earlier in this paper, most of those children come from third-world countries. For example, about 80% of them are from Asia, 15% of them live in Africa, and 5% of them live in Latin America. Other countries are also not left out. Countries like Germany, Britain, and France also experience 6% to 14% of marasmus cases among their children. In addition, nations such as turkey experience as much as 32% of marasmus cases. Cases of malnutrition in France and Brazil have been on the rise. The mortality rate because of marasmus is 5 million per annum for children below the age of five. Out of the 5 million children, about 230 million of them suffer from stunting while about 70 million of them suffer from wasting.
Marasmus has no racial predisposition. However, it is clear that it is strongly linked with poverty and poor regions. Poverty denies people of the ability to eat enough and well balanced food. It is therefore likely to be higher among the Latinos, Africans, and Asians. In the same way, marasmus is not in anyway predisposed by sex. Both male and female are equally victims of malnutrition. However, in some cultures, girls and women are prohibited from eating certain food, hence depriving them of some important nutrients. On the other hand, marasmus has age predisposition. For example, it is more prevalent in children who are below the age of five. In fact, in these early years of development, there is high-energy demand in the body. Children who are born in drought areas are therefore likely to face poor weaning nutrients. Their parents are also likely to be poor and unemployed. Hence, they fail to provide them with enough food. In arid and poverty-stricken areas, the level of literacy is also very low. Low levels of education would mean that parents to most of the children do not have information on nutrition. Consequently, such parents would feed their children with inadequate food especially one that lacks some nutrients that are vital when it comes to prevention of marasmus. As a result, this practice paves a way for the deficiency disease.
Sign and Symptoms
The major signs and symptoms of marasmus are founded on malnutrition. A wide range of wasting of muscles and tissues characterizes the victim. The victim loses energy. He or she then appears weak and unable to carry out the normal activities. In other instances, victims of marasmus suffer from edema. The condition is also characterized by dryness of the skin. In some cases, the victim’s skin becomes scaly and cracked. The skin may also lose its ordinary folds. The body of the victim also develops a hanging skin especially around the buttocks and armpits. Hanging of the skin results from lack of the necessary nutrients that support skin growth and development in the body of the victim. The victim also depicts symptoms such as quick loss of body fats in areas where the body stores its fats. For example, there are little or no fat contents around the buttocks. Victims of marasmus also have a pitiful appearance. In fact, sometimes, they become very irritable. They feel neglected and deprived. Since the victims are hungry in most cases, they are not likely to interact freely with their age mates. The diseases can also result in depression-like symptoms. The child may look irritable and in deep thought.
Treatment
Treatment of marasmus highly depends on the level that the disease by the time it is noticed. Treatment can be offered through outpatient and inpatient mode. If the condition is not complicated and not life threatening, it can be managed through outpatient method. Treatment can therefore be divided into several stages. These stages are initial intensive stage, rehabilitation stage, and outpatient stage. The management of marasmus in the initial stage will therefore aim at ensuring that various conditions are managed and prevented. For example, treatment and prevention of hypothermia control of dehydration, management of hypoglycemia, ensuring electrolyte imbalance, and management of micronutrient deficiency and dehydration. Every opportunistic infection that attacks the patient due to low body prevention mechanism should be managed quickly.
The initial treatment stage of marasmus will also involve feeding patients with special foods. Such foods should be aimed at enhancing growth and/or ensuring growth recovery. Special foods should also ensure stabilization of the health status of the victim. Healthcare providers and family members should also ensure that the patient is provided with care and even body stimulation mechanism. Healthcare providers should also plan for follow-ups after discharge.
The major focus that healthcare officials should target is nutrition management. The patient should be provided with food that carries 100Kca/kg/d to 150Kcal/kg/d. The patient should also be re-hydrated using clean and healthy water. Healthcare providers should also treat diarrhea through the provision of sugar and salt re-hydration solution. Treatment of marasmus should also involve health condition screening. Before commencing any treatment of patient suffering from marasmus, proper screening should be carried out. Provision of vitamins is also important while treating marasmus, for example, provision of foods rich in vitamin E, K , B, and A since vitamins are crucial in ensuring that prevention mechanisms are rejuvenated. Health education is another important facet of marasmus treatment. The patient and healthcare providers should have information about proper nutrition. There is the need to provide social-cultural health and nutrition education. When the patient is a child below the age of five, the mother of the child should be part of the healthcare providers. The major aim of this stage is to ensure tissue renewal. The patient should be assisted to have stable electrolyte balance, hypothermia, and hypoglycemia. Children can be treated through oral nutrition immediately after the imbalance is corrected.
It is also important to isolate children suffering from marasmus or those with other infectious diseases. This strategy will prevent disease transmission from one child to the other. The environment in which patients are treated should also be warm. When the child is shocked, the healthcare provider should provide Ringer’s solution to make the child’s condition stable. Use of F75 solution should also be used to supply patients with carbohydrates. This solution is recommended since it contains 75kcal/100ml.
In the second stage of rehabilitation, the patient should be provided with 200kcal/kg/d of nutrition. This will ensure restoration of body weight. The child should be made to eat enough nutritious food. Nutritional management should also be managed in this stage. The mother to the child should also be well fed. Breast-feeding is the best source of nutrients especially for children below the age of five. In this stage, F100 formula is used to provide protein to the patients’ body.
In the acute management stage, the healthcare providers aim at managing infections. Such action includes the treatment of diarrhea, pneumonia, malaria, dehydration, and urinalysis. These infections cause death in most children suffering from marasmus. Treatment of bacterial infections should be done. Heart failure and anemia are also treated in this stage. Marasmus can be managed especially when detected on its early stages.