Child Malnutrition - What? How? And when to Refer.. [MUSIC PLAYING] NARRATOR: Worldwide, malnutrition affects one in three people. Malnutrition contributes to between 35% and 55% of all childhood deaths, or even more in acute emergency situations. There are two common types of malnutrition. Firstly, there is protein energy malnutrition which results from a diet lacking all major macronutrients, such as carbohydrates, fats, and proteins. Secondly, there is nutrient malnutrition caused by a diet lacking essential vitamins and minerals. Malnutrition can cause several conditions, such as [INAUDIBLE], which commonly manifests itself through accumulation of fluids in the tissue. [INAUDIBLE] sufferers appear skeletal, thin, or stunting, a long-term effect of malnutrition resulting in short height or length for a particular age. Using this knowledge, one can easily assess if a child is malnourished. For infants less than six months old, you should observe for visible severe wasting of the muscles of shoulders, arms, buttocks and legs. In extreme cases, there may be folds of skin on buttocks and thighs. Other indications are if the child's ribs can easily be seen and if the legs appear small compared to the abdomen and waist. For children aged six months and more, a more conclusive test is the mid-upper arm circumference measurement. For this, ask the mother or carer to uncover the child's arm. Estimate the midpoint of the left arm. Straighten the child's arm and wrap the tape around the midpoint, make sure the numbers are right side up and the tape is flat around the skin. Inspect the tension of the tape on the child's arm. Make sure the tape has the proper tension and is not too tight or too loose. Repeat any step if necessary. When the tape is in the correct position and correct tension on the arm, read and call out the measurement to the nearest tenth of a centimeter. Immediately record the measurement. And finally, one should feel for edema on both feet by pressing gently with the thumb on the top side of each foot for at least three seconds. If a dent remains following the pressing, this is called pitting edema. After performing these tests, it may be necessary to refer the child to a medical officer or a hospital. If a child under six months has visible signs of severe wasting or edema of both feet, they must be referred. If a child older than six months has a mid-upper arm measurement of less than 11.5 centimeters or pitting edema and a medical complication such as pneumonia, diarrhea, and fever, they must also be referred. [MUSIC PLAYING]