Putting malnutrition in context

An estimated 149 million children under five years old around the world suffer from malnutrition, which is an underlying contributing factor in nearly half of all deaths in this age group.

Malnutrition remains one of the most pressing and complex challenges facing the world today. According to the latest Global Report on Food Crises, nearly 282 million people across 59 countries and territories faced severe acute hunger in 2023—an increase of 24 million since 2022, when numbers were already alarmingly high. This surge is caused by sharp deteriorations in food security, especially in Gaza and Sudan. This is the fourth consecutive year of strikingly high food insecurity across the world. Doctors Without Borders/Médecins Sans Frontières (MSF) continues to respond to the malnutrition crisis around the world, and our teams implemented considerable interventions in 2023.

People become malnourished if they are unable to take in enough or fully utilise the food they eat, due to illnesses such as diarrhoea, measles, HIV, and tuberculosis. When children suffer from acute malnutrition, their immune systems are so impaired that they become more vulnerable to other diseases. Nearly half of deaths among children under five years old worldwide are linked to undernutrition, which can include wasting, stunting, being underweight, and suffering from deficiencies in vitamins and minerals. These deaths mostly occur in low- and middle-income countries. MSF estimates that only three percent of the 20 million children suffering from severe acute malnutrition receive the lifesaving treatment they need.

We can help prevent more children from dying if we change the way food aid is delivered.

309 million

people worldwide face chronic hunger

67%

of admissions to MSF's outpatient therapeutic feeding centers in 2023 were in just three countries: Nigeria, Niger, and Chad

660,500

660,5

children with malnutrition were treated in MSF's inpatient and outpatient therapeutic feeding programs in 2023

MSF, Doctors Without Borders,Malnutrition Crisis in Zamfara state, Nigeria — Hamida Usman sits beside her daughter who is suffering from malnutrition, in the Inpatient Therapeutic Feeding Centre, General Hospital, Shinkafi, Zamfara state, Northwest Nigeria.

What causes malnutrition?

In the first six months of life, breast milk is the only food a child needs—but beyond this point, breastfeeding alone is not sufficient. Diets at this stage must provide the right blend of high-quality protein, essential fats and carbohydrates, vitamins, and minerals. In the Sahel, the Horn of Africa, and parts of South Asia, highly nutritious foods such as milk, meats, and fish are severely lacking.

The critical age for malnutrition is from six months—when mothers generally start supplementing breast milk—to 24 months old. However, children under five, adolescents, pregnant or breastfeeding women, the elderly, and the chronically ill are also vulnerable.

For a child under the age of two, their diet will have a profound impact on their physical and mental development. Malnourished children under the age of five have severely weakened immune systems and are less resistant to common childhood diseases. This is why a common cold or a bout of diarrhea can kill a malnourished child.

MSF, Doctors Without Borders, A year in Pictures 2024 — Maryam gets a supply of supplementary feeding product as she stays in the intensive care ward of MSF’s inpatient nutrition hospital in Maiduguri with her mother Maryam.

What are the symptoms of malnutrition?

Understandably, the most common sign of malnutrition is weight loss. Loss of weight may also be accompanied by a lack of strength and energy and the inability to undertake routine tasks. Those who are malnourished often develop anemia and therefore exhibit a lack of energy and breathlessness.

In children, signs of malnutrition may include an inability to concentrate or increased irritability, and stunted growth. In cases of severe acute malnutrition, swelling of the stomach, face, and legs, and changes in skin pigmentation may also occur.

At an MSF mobile clinic in Girbanat, a child in triage is being measured using the MUAC (Mid-Upper Arm Circumference) to assess the level of malnutrition. The MUAC is part of the triage protocol for all children under 5 before they proceed to consultation.

How is malnutrition diagnosed?

Malnutrition is diagnosed by comparing standard weights and heights within a given population, or by the measurement of a child’s mid-upper arm circumference (MUAC).

If dietary deficiencies are persistent, children will stop growing and become ‘stunted’—meaning they have a low height for their age. This is diagnosed as chronic malnutrition.

If they experience weight loss or ‘wasting’—low weight for one’s height—they are diagnosed as suffering from acute malnutrition.

This occurs when a malnourished person begins to consume his or her own body tissues to obtain needed nutrients.

In the severe acute form, children with kwashiorkor—distended stomachs—can be clinically diagnosed with body swelling, irritability, and changes in skin pigmentation.

An MSF nurse and laboratory assistant from the Ministry of Health, explaining to a patient how to properly feed her child the ready-to-use therapeutic foods (RUTF) to help care for the malnourished child. — MSF nurse, Isata Conteh and laboratory assistant from the Ministry of Health, Idrissa Bah, explaining to a patient how to properly feed her child the ready-to-use therapeutic foods (RUTF) at the Kamaranka tuberculosis Direct Observation Therapy (DOT) site in Bombali District, Sierra Leone.

How is malnutrition treated?

We believe that ready-to-use therapeutic food (RUTF) is the most effective way to treat malnutrition. RUTFs include all the nutrients a child needs during its development and helps reverse deficiencies and gain weight. RUTFs don’t require water for preparation, which eliminates the risk of contamination with water-borne diseases.

Because of its packaging, RUTFs can be used in all kinds of settings and can be stored for long periods of time. Unless the patient suffers from severe complications, RUTFs also allow patients to be treated at home.

Where malnutrition is likely to become severe, MSF takes a preventative approach by distributing supplementary RUTF to at-risk children.

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MSF screens communities for potential malnutrition by conducting nutritional assessments and during almost all of our outpatient and inpatient services not dedicated specifically to nutrition and during other interventions. Our teams assess children by comparing their weight-for-height ratio to international WHO standards, and/or by measuring a child’s mid-upper-arm circumference (MUAC) using color-coded paper bracelets. MUAC measurements are also simple enough to be used at a village level by community health workers.

The widespread use of ready-to-use therapeutic food (RUTF) that can be stored long-term without refrigeration and contains a specific balance of nutrients allows us to more effectively fight against malnutrition. RUTF can be either a paste, much like peanut butter, or in a biscuit form. The majority of children can be treated at home by their family with follow-up appointments at a clinic. This strategy can result in cure rates of over 90 percent and reduce referral to inpatient care.

In some regions, our teams run malnutrition prevention projects to stop children falling ill, especially after a yearly “hunger gap”. MSF starts working and sets up outpatient clinics months before malnutrition cases peak at the start of the rainy season.

In areas where malnutrition is likely to become severe, our teams take a preventative approach by distributing a nutritious supplement to at-risk children across Africa and Asia and making sure other disease prevention initiatives, like vaccinations and malaria chemoprophylaxis, are implemented.

MSF teams distributing ready-to-use therapeutic food supplements to help combat malnutrition in children in South Sudan — MSF staff distribute ready to use therapeutic food supplements, buckets, jerry cans, soap, cooking pots, plastic sheeting, rope and mosquito nets to people displaced from the conflict in Upper Nile State, South Sudan.

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Putting malnutrition in context

309 million

309 million

67%

67%

660,500

660,5

Quick facts about malnutrition

What causes malnutrition?

What are the symptoms of malnutrition?

How is malnutrition diagnosed?

How is malnutrition treated?

FROM THE FRONTLINES

MSF Renews Call for Immediate Action to Prevent Death and Starvation in Sudan

How MSF responds to malnutrition

Your support matters

Iraq: Babies most affected by malnutrition around Mosul

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