Severe malnutrition

The literature on the effects of severe protein-energy malnutrition on child development mostly concerns children who were in hospital with kwashiorkor, marasmus, or marasmic-kwashiorkor based on the old Wellcome classification [105]. These studies were recently reviewed in depth [106]. The main conclusions were, in spite of limitations of study design, that the evidence was strong but not unequivocal that severe malnutrition in early childhood leads to deficits in cognitive development and behaviour differences if the children return to poor environments. However, marked improvements are possible with vast improvements to the children's environment, such as occurs in adoption. More feasible simple interventions in the children's own homes can produce some benefits. However, the evidence for this is limited. The policy implications are that wherever severely malnourished children are being treated, attention should be paid to promoting the children's mental development