Marasmus Follow-up

Updated: Oct 04, 2016
  • Author: Simon S Rabinowitz, MD, PhD, FAAP; Chief Editor: Jatinder Bhatia, MBBS, FAAP  more...
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Follow-up

Further Outpatient Care

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  • Relapse: Because risk of relapse is greatest soon after discharge, the child should be seen after 1 week, 2 weeks, and 1 month. At each visit, the health worker must be sure that all the points mentioned above are assessed. The child must be measured, weighed, and the results recorded. Immunization should be performed according to national guidelines.
  • Neurodevelopmental assessment: During the first 2 years of life, the nervous system is growing and particularly at risk if nutritional deficiencies are present; therefore, regular assessment of neurodevelopment is important, including head growth measurement, neurodevelopmental item assessment, and intelligence quotient (IQ) evaluation at each visit.
  • Long-term care: Long-term follow-up care should be encouraged, particularly regarding somatic growth and neurodevelopmental performances.
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Further Inpatient Care

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  • Preparing for discharge in patients with marasmus: During rehabilitation, do everything possible to ensure that the child is fully reintegrated into the family and community after discharge. Include the child, the mother, and the health care worker.
  • Child
    • Appropriate weight for height (-1 standard deviation [SD])
    • Eating well and gaining weight
    • Infections properly treated
    • Immunization started
  • Mother
    • Able to look after the child
    • Able to prepare appropriate food
    • Able to provide home treatment for diarrhea
    • Able to recognize the signs that mean she must seek medical assistance
  • Health care worker - Able to ensure the follow-up care of the child
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Deterrence/Prevention

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  • Inappropriate development, poverty, armed conflict, mishandling of funds, lack of education (particularly women's illiteracy), as well as limited access to medical care represent the primary underlying causes of malnutrition. The best preventive strategies should address these underlying problems.
  • Numerous prevention programs have been implemented, among which the most successful include the following:
    • Educational programs for girls
    • Sanitation programs, which improve access to safe water
    • Nutritional programs, including health education as well as screening of malnourished children
    • Programs that integrate breastfeeding promotion, diarrhea and infection therapy, and improvement of the nutritional status of mothers and pregnant women
  • Interestingly, programs aimed at improving technical infrastructures, such as electrical networks and information networks, have not demonstrated a positive preventive effect.
  • Integration of preventive action with national policies of education and family planning are necessary conditions for the success of these actions. Integrated action should also include screening, medical care, and follow-up. The frequent failures of preventive programs are often due to unsuitable nutrition interventions, insufficient treatment of diarrheal disease, or operational difficulties. However, ongoing evaluation can decrease the risk of failure.
  • Other key factors in prevention program success are clear strategic objectives, motivated and competent leaders, continuous training at every level, and regular evaluation of the objectives and achievements. Integration with the existing health care system, as well as national and international political support, is critical.
  • An international task force recently published an in-depth analysis of the impact of interventions for maternal and child undernutrition. [44] These authors determined that the management of severe acute malnutrition using the WHO guidelines in the developing world reduced the case fatality rate by 55%. In addition, using effective micronutrient interventions in pregnant mothers and their infants in the 36 countries that account for 90% of the children with stunted growth reduced overall stunting at 36 months by 36%. The authors concluded that further improvements would require correction of the fundamental underlying causes of marasmus, including poverty, poor education, disease burden, and lack of women's empowerment.
  • The prevalence of marasmus has been recognized to dramatically increase in a vulnerable cohort in the face of natural disasters. [45, 46] A comprehensive review from the Global Nutrition Cluster on the use of lipid-based supplements as an emergency measure during these crises is now available. [47]
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Complications

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  • Complications of the acute phase of malnutrition have been discussed (see Medical Care). Several complications can lead to permanent sequelae.
  • Long-term sequelae, with particular attention to developmental issues, must be mentioned. If growth and development have been extensively impaired and if early massive iron deficiency anemia is present, mental and physical retardation may be permanent. Apparently, the younger the infant at the time of deprivation, the more devastating are the long-term effects.
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Prognosis

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  • Except for complications mentioned above, prognosis of even severe marasmus is good if treatment and follow-up care are correctly applied.
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Patient Education

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  • Teaching parents how to prevent malnutrition is of high importance to prevent recurrence. They must understand the causes of malnutrition, how to prevent its recurrence (including correct feeding), and how to treat diarrhea and other infections. They have much to learn and need considerable care from the medical staff.
  • For excellent patient education resources, visit eMedicineHealth's Digestive Disorders Center. Also, see eMedicineHealth's patient education article Gastroenteritis.
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