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In the past, severe acute malnutrition was classified in the way described in Box 6. You need to know this, because you may come across people who still use these terms. Marasmus: Severe form of acute malnutrition that is characterised by wasting of body tissues. However there is now a new way of classifying malnutrition so you need to know and should use these terms. With the current classification, all the three forms of severe protein energy malnutrition are now classified as severe acute malnutrition. These factors often act in a continuous cycle and include dietary intake issues, diseases, food insecurity, inadequate maternal and child health care and sanitation services. Illiteracy and poverty may also influence the food intake of people in your community and become causes of malnutrition. Document your discussions and possible causes in your Study Diary and discuss your findings with your Tutor. Because the causes of malnutrition are complex, they should be addressed in a systematic way in order to find the right solutions for the problem. Usually malnutrition is not the single consequence of a single factor but a mixture of different causes. You will see that the causes of malnutrition have been divided into three main headings: the basic causes; the underlying causes; and the immediate causes. The poor diet might be due to not enough food, or a lack of variety of foods in meals; low concentrations of energy and nutrients in meals; infrequent meals; insufficient breastmilk; and early weaning. Disease: Diseases, especially infectious diseases, cause undernutrition because a sick child may not eat or absorb enough nutrients, or may lose nutrients from the body due to vomiting or diarrhoea, or have increased nutrient needs which are not met. As you can see from the figure, infection will lead to undernutrition and the undernutrition also leads to infection. The underlying causes differ within different communities and from family to family but it is useful to group them into: family food shortages; inadequate care of children and women; unhealthy environment and poor health services; and too many children in a family to feed.

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