Protein-Energy Malnutrition

Protein-energy malnutrition (PEM) is a condition resulting from inadequate intake of protein and calories relative to the body's needs, most commonly affecting young children in low-resource settings. It remains a significant public health concern in parts of Nigeria, particularly in areas affected by food insecurity, poverty, and recurrent infections, and includes conditions such as kwashiorkor and marasmus. Early identification and nutritional support are critical, as PEM affects growth, immunity, and development, especially in children under five.

• Poor weight gain or weight loss • Stunted growth (short height for age) in chronic cases • Visible wasting: thin arms and legs, loss of muscle and fat • Swelling of the feet, legs, or face (oedema) — a feature of kwashiorkor • Changes in hair: thinning, loss of colour, or easy pluckability • Skin changes: dryness, peeling, or sores • Lethargy, irritability, or apathy • Delayed developmental milestones in children • Frequent infections due to weakened immunity • A distended abdomen in some children

PEM develops when the body does not receive enough protein and calories to meet its needs, or when illness increases nutritional requirements beyond what is being consumed. Common contributing factors include: • Inadequate food intake due to poverty or food insecurity • Early cessation of breastfeeding or inappropriate complementary feeding • Repeated infections (diarrhoea, measles, respiratory infections) that increase nutrient needs and reduce absorption • Poor maternal nutrition during pregnancy and breastfeeding • Underlying illness affecting nutrient absorption or increasing metabolic demand

• Poverty and household food insecurity • Young age, especially children under 5 • Large family size with limited resources • Poor access to clean water and sanitation, leading to recurrent infections • Low maternal education and limited knowledge of infant feeding practices • Living in areas affected by conflict, displacement, or drought • Premature birth or low birth weight

• Weakened immune system, leading to severe and recurrent infections • Stunted physical growth and impaired cognitive development • Increased risk of death, particularly in severe cases • Delayed wound healing • Long-term effects on learning and productivity • Electrolyte imbalances and organ dysfunction in severe cases

• Exclusive breastfeeding for the first 6 months of life, continued alongside complementary foods up to 2 years • Timely introduction of nutritious, diverse complementary foods from 6 months • Regular growth monitoring at child welfare clinics • Prompt treatment of infections, especially diarrhoea • Ensuring access to clean water and good sanitation • Nutritional support and education for pregnant and breastfeeding mothers • Community and government nutrition support programmes for vulnerable families