5.5.4  Visible severe wasting

In order to determine the presence of visible severe wasting for children younger than six months, you will need to ask the mother to remove all of the child’s clothing so you can look at the arms, thighs and buttocks for loss of muscle bulk. Sagging skin and buttocks indicates visible severe wasting (as you can see in Figure 5.13).

A child with severe visible wasting
Figure 5.13  A child with severe visible wasting. (Source: Ethiopian Federal Ministry of Health, 2010, Training course of the out patient treatment programme of severe acute malnutrition)

Table 5.4 summarises the main symptoms of nutritional problems and the deficiencies they signal.

Table 5.4  Clinical signs and symptoms of nutritional problems.
Sign/symptomNutritional abnormality

Pale: palms, conjunctiva, tongue

Gets tired easily; loss of appetite shortness of breath

Anaemia: may be due to the deficiency of iron, folic, vitamin B12, acid, copper, protein or vitamin B6
Bitot’s spots (whitish patchy triangular lesions on the side of the eye)Vitamin A deficiency
Goitre (swelling on the front of the neck)Iodine deficiency disorder
  • Aster is a one-year-old girl who was brought to your health post by her mother, with a complaint of body swelling and poor appetite for one month.

    Upon anthropometric assessment her weight-for-height was less than 3 SD and on examination, she has bilateral pitting oedema. What is the nutritional problem Aster is suffering from and what are the indicators?

  • Aster’s weight-for-height index is an indicator of severe underweight and this, combined with the bilateral pitting oedema, tells you that she has severe acute malnutrition.

5.6  Dietary methods of assessing nutritional status