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close this book Community Nutrition Action for Child Survival
close this folder Part I - Community nutrition problems and interventions
close this folder Unit 1 - The nutrition of women and children
View the document Session 1: What is malnutrition?
View the document Session 2: Focus on the nutrition of women and children
View the document Session 2: Focus on women and children
View the document Session 3: Important causes of malnutrition in women and children
View the document Session 4: Community nutrition action for child survival

Session 1: What is malnutrition?

Most trainees will have been exposed to basic nutrition principles in their work. This introductory session is intended as a review; however, it may include information new to some trainees. You should develop the session content based on a pre-training assessment of the trainees' knowledge about the nutrition of women and children.


Participants will discuss general nutritional requirements for growth and development. Inadequate diet and illness will be defined as the primary causes of malnutrition in individuals.

Time: 1-3 hours


- Flipchart and marking pens

- Slides and projector or posters showing the symptoms of severe malnutrition

- Handout - "Malnutrition"


1. Read the statement below to the group, or substitute statements about malnutrition in your country. Ask trainees to think about the statement for a few seconds.

"About 17 million of the world's children under five years old died last year; more than 12 million died from diarrhea, pneumonia, and contagious infections. Malnutrition was an underlying cause in all of these deaths. " UNICEF, A Child Survival Revolution, 1983

2. Ask trainees: "What is malnutrition?". Write the answers on the flipchart. Encourage as many answers as possible. The list will often include effects and causes, as well as definitions of malnutrition.

3. Referring to the trainees' answers in 2. above, give the definition of the term "malnutrition" as it will be used throughout the workshop:

Example: "Malnutrition is the physical and mental disability that results when the human body does not get the nutrients it needs to grow and function properly. "

4. Review the basic nutrient requirements for growth and development. Explain the classification of foods according to their primary functions in the body

(use the Basic Three Food Groups or the system of classification used in your country). In groups without nutrition background, conduct an exercise in which trainees practice classifying local foods or pictures of local foods according to their primary functions in the body, e.g., Basic Three Food


5. Ask: " Why do people become malnourished?"

Trainees will give a variety of answers. List their answers on the flipchart; then summarize by saying:

"We can see that there are many reasons people become malnourished. We will be talking about many of the causes of malnutrition during this workshop. In this session, let us begin by talking about the biological causes of malnutrition in the individual. "

6. Explain that the physical causes of malnutrition are:

- inadequate diet

- not eating enough food; not eating enough of certain kinds of food (e.g., foods from each of the three food groups);

- illness.

7. Explain how illness can cause malnutrition by:

- reducing the amount of food eaten;

- reducing the intestine's ability to absorb (use) the food eaten;

- increasing the body's demand for available nutrients.

Describe the body's reaction to specific illnesses (i.e., diarrhea, measles and parasitic infections) and how they affect food intake and use by the body.

8. Draw the cycle of malnutrition-infection to illustrate the following points.

- Malnutrition weakens the body, making it more susceptible to illness, so people who are malnourished get sick more often.

- Illness often reduces nutrient intake at a time when the body needs more nutrients than normal to fight infection.

- Repeated illness complicates and intensifies malnutrition.


9. Ask trainees to brainstorm the signs and symptoms of malnutrition. When they finish, add any additional physical signs and divide the signs into those related to Protein Energy Malnutrition (PEM) and those related to specific vitamin and mineral deficiencies. You may wish to illustrate the signs of severe malnutrition using slides or posters.

Remind trainees that these different types of malnutrition often occur together.

10. Summary

"In this session we have seen that malnutrition is the result of:

- not eating enough food;

- not eating enough of certain kinds of foods;

- illness.

In the next activities, we will be analyzing the nutrition problems of women and young children and identifying community activities that address the immediate causes of malnutrition."

Distribute the Handout - Malnutrition" as a reference.



Malnutrition has been identified as one of the world's most serious health problems and a major cause of death in infants and young children. Last year 17 million children under five years of age died throughout the world: 12 million of them died from diseases directly related to malnutrition. (UNICEF, A Child Survival Revolution, 1983)

What is Malnutrition?

Malnutrition is the physical and mental disability that results when the body does not get the nutrients it needs to function and grow. The body gets nutrients from foods. Foods contain different combinations of nutrients, so the body needs different kinds of foods to meet its nutrient requirements. The functions of food in the body can be divided into three categories building and repairing the body's tissues, providing energy and strength, and maintaining or protecting the body from illness.

The Basic Three Food Groups

In order to understand the combinations of foods necessary for growth and health, we often divide the foods according to what they do in the body. A common system for classifying foods is the Basic Three Food Groups. (There are also systems for classifying foods by function and nutrient content that include four, five and six classifications.)

The Basic Three Food Group System divides foods into Body-Building, Energy and Protective categories.

Body-Building Foods (protein) are used by the body for growth and repair of tissue. These foods are very important for everyone, but they are most important for young children who are growing very rapidly and for pregnant and breastfeeding mothers who are nourishing growing babies as well as themselves. The Body-Building Foods include milk, eggs, legumes, fish, meat, poultry, nuts, etc.

Energy Foods (carbohydrates and fats) are those that help us do all of the things we must do every day, i.e., work, walk, play, etc. These are very important foods and they usually make up the bulk of the diet. Energy Foods include cereal grains, roots and tubers, fats and oils, sugars, etc.

Protective Foods (vitamins and minerals) are those that help keep the body free from sickness and functioning properly. These foods include fruits and vegetables, especially dark green and yellow vegetables and fresh fruits.

The body needs some of each of these kinds of food every day to stay healthy. There are also special times when the body needs more food than normal to grow and stay healthy. These include periods of rapid growth, sickness and heavy physical labor.

What Causes Malnutrition?

When the body does not get enough of the foods it needs; when it does not yet the right combinations of food; or, when illness affects the body's ability to use foods properly, a person may become malnourished.

Diets may be deficient in the quantity and the quality of food consumed. This means that the amount of food eaten and/or the nutritional value of the food is below the daily human requirement. The minimum nutrient requirement varies according to the age, size and reproductive status of the individual.

Protein Energy Malnutrition (PEM), one of the most serious nutritional problems, is caused by inadequate intake of body-building and/or energy foods and is usually accompanied by nutritional anemia. Kwashiorkor and marasmus are two types of PEM.

Vitamin and Mineral Deficiencies also cause malnutrition. Anemia (iron), xerophthalmia (vitamin A), rickets (vitamin D) and goiter (iodine) are related to vitamin or mineral deficiencies. Some of these vitamin and mineral deficiencies also occur with protein energy malnutrition.

Illness affects the body's ability to digest and use food, as well as the amount of food eaten. Diarrhea is a good example of an illness that causes malabsorption as well as reduced intake of food. When diarrhea occurs, the intestine is unable to absorb many of the nutrients contained in the food. If the person with diarrhea is feeling unwell, or if there is vomiting, there will also be less food eaten than normal. In some cultures, children with diarrhea may also be taken off food during bouts of diarrhea. Because the body actually requires more nutrients than normal to fight infection, illnesses like diarrhea have a double impact on nutrition status.

What are the Effects of Malnutrition?

Malnutrition causes growth failure, increased risk of infection, physical changes in the body, illness, disability and death. Malnutrition impairs the body's defense systems for fighting infection, meaning that the malnourished become sick more often and suffer more from their illnesses than the well-nourished. This vicious cycle of malnutrition and infection leads to reduced productivity of workers, high drop-out and repeater rates among school children, a greater demand for health and hospital care, high expenditures by the government and waste of human life.






Hair changes

Lack of Body


"Flaky paint" rash

Building and


Swelling (edema)

Energy Foods








Lack of total


"Old man" look

food intake




Skin hanging on bones



Night blindness

Lack of


Bitot's spot

vitamin A






Pale conjunctiva ( eye)

Lack of iron






Pale mouth and tongue


Notched ribs

Lack of


Bowed legs

vitamin D


Enlarged thyroid

Lack of








* These are signs of severe forms of malnutrition. In most cases, people showing these signs have been malnourished for a long time. Although they may not have had visible physical signs of malnutrition, they may have experienced fatigue and sickness. In children, the first sign of malnutrition (PEM) is failure to grow.