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Undernutrition: PEM, wasting, stunting and the link with infection sheet
10-mark answer frame

Discuss the etiology, clinical features and prevention of protein energy malnutrition.

How to lay out the answer. Follow the frame, then write it in your own words.

  1. 1 · Open in two lines. PEM is a range of conditions caused by a lack of energy and protein, seen mostly in children under five. It shows as underweight, stunting and wasting.
  2. 2 · Forms and prevalence.
    • Underweight, stunting and wasting with the WHO cut-offs (below −2 SD).
    • NFHS-5 (2019-21): stunting 35.5%, wasting 19.3%, underweight 32.1%.
  3. 3 · Draw the kwashiorkor-marasmus table. [Table: oedema, face, hair, skin, liver, appetite and mood, usual age]
  4. 4 · Wellcome classification. 60-80% of reference weight with or without oedema; below 60% with or without oedema.
  5. 5 · Causes.
    • Immediate: poor diet and infection.
    • Underlying: food insecurity, poor feeding practices, unsafe water.
    • Basic: poverty, illiteracy, low status of women.
  6. 6 · Draw the malnutrition-infection cycle. [Cycle: poor diet → weight loss → lowered immunity → infection → appetite loss and nutrient loss → poor diet]
  7. 7 · Prevention in the community. Breastfeeding and complementary feeding, ICDS supplementary nutrition, growth monitoring, immunisation, ORS and zinc, deworming, PDS grains, NRCs for SAM.
  8. 8 · Close in one line. PEM is preventable when food, health care and good care practices reach the child together.

Scoring tip: Quote NFHS-5 with its years. The comparison table and the cycle diagram earn marks quickly.