Maras is a severe form of protein-energy malnutrition, characterized by extreme wasting of fat and muscle tissue. Primarily affecting infants and young children, it represents a significant global health challenge, especially in regions with food insecurity and inadequate healthcare. Its profound physical deterioration impacts a child’s development and survival.
Causes of Maras
The primary cause of maras is a profound deficiency in total calorie intake. This inadequate dietary intake often stems from chronic food scarcity, limiting access to nourishing food. Children may not receive enough energy, leading to the body breaking down its own tissues for fuel.
Recurrent infections also contribute to maras by increasing nutrient demands and impairing absorption. Episodes of diarrhea, measles, or tuberculosis deplete nutrient stores and reduce appetite, exacerbating malnutrition. Illness diverts energy from growth and repair, deepening the state of malnutrition.
Improper feeding practices are another factor, particularly in infancy. Inadequate breastfeeding, like early cessation or infrequent feeding, deprives infants of nutrition and protective antibodies. Diluted formulas or contaminated water introduce pathogens and offer insufficient calories, contributing to severe energy deficits.
Socioeconomic factors underpin these immediate causes. Poverty limits a family’s ability to procure sufficient and diverse food, while lack of education can lead to suboptimal feeding and hygiene. Poor sanitation increases the risk of recurrent infections, predisposing vulnerable children to severe malnutrition.
Recognizing the Signs of Maras
Recognizing maras involves observing distinct clinical manifestations, primarily a profound loss of muscle and subcutaneous fat, leading to a “skin and bones” appearance. Ribs become prominent, and limbs appear extremely thin, reflecting severe muscle atrophy. The absence of cushioning fat makes bones easily palpable.
A characteristic sign is loose, wrinkled skin, particularly on the buttocks and thighs, resembling “baggy pants” due to the loss of underlying fat and muscle. The face may exhibit an “old man’s face” or “monkey face” appearance from depleted buccal fat pads, giving the eyes a sunken, gaunt, aged look.
Children often display apathy and withdrawal, yet can be irritable when disturbed. Despite severe emaciation, some children may maintain a normal or even increased appetite, unlike those with other forms of malnutrition. This preserved appetite can mask the condition’s severity.
Temperature regulation is often impaired, leading to cold extremities due to reduced metabolic rate and decreased insulating fat. Growth faltering is consistent, with children exhibiting reduced weight-for-height/length and stunted linear growth. Prolonged malnutrition can also lead to developmental delays, affecting cognitive and motor milestones.
Diagnosis and Treatment Approaches
Diagnosis of maras relies primarily on clinical assessment, including physical examination and anthropometric measurements. Healthcare professionals evaluate the child’s appearance for signs of severe wasting, noting the absence of subcutaneous fat and muscle mass. Anthropometric measurements like weight-for-height/length and mid-upper arm circumference (MUAC) quantify the degree of malnutrition. A MUAC measurement below 11.5 cm for children aged 6-59 months indicates severe acute malnutrition.
Treatment for maras follows a phased approach to restore health and avoid complications. The initial phase focuses on stabilization, addressing life-threatening conditions. This includes managing dehydration, electrolyte imbalances, hypothermia, and co-existing infections. Small, frequent feeds of therapeutic milk formulations are also initiated during this stage.
Following stabilization, the rehabilitation phase aims for rapid weight gain and catch-up growth. This involves a gradual increase in feed quantity and energy density, often using therapeutic milks or ready-to-use therapeutic foods (RUTFs). RUTFs are peanut-based pastes fortified with vitamins and minerals, providing high-quality nutrition in a home setting. This allows for sustained nutritional support.
The final stage involves follow-up care, ensuring the child gains weight and recovers fully, and providing nutritional education to caregivers. Refeeding must be cautious to prevent refeeding syndrome, a potentially fatal complication from rapid electrolyte shifts when fed too quickly. This syndrome can lead to cardiac, respiratory, and neurological dysfunction, requiring a carefully monitored refeeding protocol.
Preventing Maras
Preventing maras involves a multi-faceted approach focused on adequate nutrition and reducing infection exposure. Promoting exclusive breastfeeding for the first six months is foundational, as breast milk provides necessary nutrients and protective antibodies. Continued breastfeeding up to two years or beyond, with diverse complementary foods, helps meet growing nutritional demands.
Ensuring household food security is paramount, involving stable access to sufficient, safe, nutritious, and diverse diets. This can be supported through economic development, food assistance programs, and agricultural initiatives. Improving access to clean water and promoting good hygiene and sanitation, such as handwashing and safe waste disposal, reduces infectious diseases that precipitate malnutrition.
Widespread vaccination programs prevent common childhood illnesses like measles, which can compromise a child’s nutritional status. Early recognition and prompt management of common childhood illnesses, such as diarrhea and respiratory infections, prevent severe nutritional setbacks. Community-based interventions and educational programs empowering caregivers with knowledge about proper feeding, hygiene, and disease prevention are effective in reducing maras risk.