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‘Severe malnutrition’: thinking deeply, communicating simply

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Research snapshot1

There is currently a plethora of complex technical terminology used to describe malnutrition which can confuse non-specialist audiences. Current terminology has limitations in that it emphasises being severely small (short or thin) rather than the risk of severe adverse outcomes such as mortality, morbidity or developmental delay. Furthermore, using anthropometry to define malnutrition, while valuable, does not distinguish between the state and process of malnutrition and misses children with ‘normal’ anthropometry who are deteriorating and at risk of adverse outcomes. Alternatively, it may include children who are constitutionally small with no functional/clinical impairments who may not benefit from nutrition-based treatment. Terminology distinctions have also led to nutrition ‘tribalism’ with different anthropometric deficits being managed by different communities and inadequate consideration for the context within which malnutrition is experienced.

Given these limitations, the authors propose the use of the term ‘severe malnutrition’ to define ‘any form of malnutrition associated with a high risk of severe adverse outcomes.’ This definition includes stunting, underweight, wasting, low mid-upper arm circumference, concurrence, oedematous malnutrition and micronutrient malnutrition. It provides a simple, advocacy focused term in which ‘severe’ highlights the risk of mortality/morbidity and encompasses different manifestations of malnutrition, context-appropriate anthropometric cut-offs and underlying causes.

The advantages of this terminology include providing a bridging language for increased linkages between different nutrition-related programmes, offering clarity and familiarity (both ‘severe’ and ‘malnutrition’ are widely understood and are easily translatable into most languages) and the chance to keep important technical arguments internal to avoid giving the impression to external audiences that experts do not agree on core issues. Using this term and guided by local mortality/morbidity data, countries could be freer to set context-specific programme admission criteria for ‘severe malnutrition’. 

The authors conclude that the use of the term ‘severe malnutrition’ as a complement to current terminology would enable clear, simple communication while encouraging simultaneous deep thinking about malnutrition.

 

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Endnotes

1 Kerac M, McGrath M, Connell N, et al. ‘Severe malnutrition’: thinking deeply, communicating simply. BMJ Global Health 2020;5:e003023. doi:10.1136/bmjgh-2020-003023

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‘Severe malnutrition’: thinking deeply, communicating simply. Field Exchange 64, January 2021. p74. www.ennonline.net/fex/64/severemalnutritionterminology

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