The term protein energy malnutrition covers a wide spectrum of clinical stages ranging from the severe forms like kwashiorkor and marasmus to the milder forces in which the main detectable manifestation is growth retardation. It is widely prevalent among weaned infants and pre-school children in India and other developing countries.        

CAUSES        
1. Social and Economic Factors
Poverty that results in low food availability, overcrowded and unsanitary living conditions and improper child care are frequent causes of PEM. A decline in the practice and duration of breast feeding combined with inadequate weaning practices are the important causes of PEM.

2. Biological factors
Maternal malnutrition prior to and or during pregnancy is more likely to produce an underweight new born baby. Infectious diseases are major contributing and precipitating factors of PEM. Diarrhoea, measles and respiratory and other infections result in negative protein and energy balance.

3. Environmental factors
Overcrowded and or unsanitary conditions lead to frequent infections like diarrhoea. Agricultural patterns, droughts, floods, earthquakes, wars and forced migrations lead to cyclic, sudden or prolonged food scarcities. Post harvest losses of food can occur due to bad storage conditions and inadequate food distribution.

4. Age
It mostly affects infants and young children whose rapid growth increases nutritional requirement. The long term intake of insufficient food can result in marasmus before one year. Kwashiorkar is common after 18 months.

KWASHIORKOR

symptoms

The diet should be from locally available staple foods - inexpensive, easily digestible, evenly distributed throughout the day and increased number of feedings to increase the quantity of food.

3. Rehabilitation

The concept of nutritional rehabilitation is based on practical nutritional training for mothers in which they learn by feeding their children back to health under supervision and using local foods.

PREVENTION