Globally symptoms thyroid proven lariam 250 mg, two billion people are susceptible to iodine deficiency problems due to inadequate iodine intake. Nearly 266 million schoolaged youngsters in the world have inadequate iodine consumption. Some 38 million youngsters are born yearly unprotected against the danger of iodine deficiency. About ninety,000 stillbirths and neonatal deaths occur yearly because of maternal iodine deficiency. Prevalence in India Anemia is extremely prevalent among the under-five kids, and pregnant women, in every state of India. Cereals and pulses which kind the staple in complementary meals are comparatively poor in iron. The indian food regimen also contains massive portions of phytates, oxalates, phosphates, etc. Chronic irritation and an infection can lead to melancholy of several indicators of iron status, like serum iron and enhance in free erythrocyte protoporphyrin. Anemia standing of the kid is closely linked with the anemia standing of the mom. Each being pregnant and parturition results in giant quantities of blood loss and several other such pregnancies at quick intervals make these women severely anemic. Children born to sociodemographically deprived mothers are additionally extra prone to be anemic because of the inappropriate alternative of food or as a end result of meals fads. Due to flooding, deforestation, glaciations, and changing rivers course the iodine present in high soil is drained continuously. This results in deficiency of iodine in crops grown on iodine deficient soil which in turn leads to low iodine in the food plan. Moreover, iodized salt coverage continues to be not complete and uniform throughout the nation. Access to meals implies bodily and financial access to sufficient quantities of nutritious, secure and culturally appropriate meals. Production of meals denotes the manufacturing methods that are economically viable, socially responsible and environmentally sustainable. Here what needs to be underlined is that while the producers should be capable of generate a good earnings, the customers should have a sizeable disposable income to afford applicable food. The government of India has introduced a Food Security Act (2013) that specifically includes provisions for prevention and management of child malnutrition, dietary support to kids, pregnant women and lactating moms. Undernutrition can be categorized as macronutrient (protein, fats, and carbohydrates) and micronutrient (vitamins and minerals) deficiency. Food security implies provision for food and nutritional safety in human life cycle strategy, by guaranteeing access to sufficient quantity of high quality food at affordable prices to individuals to reside a life with dignity. Investing within the future-a united name to action on vitamin and mineral deficiencies. Generalized adjustments in different organs could cause decreased consumption of meals, anorexia, malabsorption, nutrient loss in chronic or recurrent diarrhea and elevated energy requirement resulting into undernutrition. The situation is additional aggravated by poverty, illiteracy, unhygienic feedings, prolonged starvation throughout illness and chronic systemic issues. High prevalence of low birthweight infants and lack of exclusive breastfeeding are the two necessary components which result in excessive incidence of undernutrition within the growing nations. The two extreme forms of undernutrition such as marasmus and kwashiorkor are the results of these physiological alterations. The adrenocortical response to stress due to protein and calorie deficiency determines the development of these two types of undernutrition. Golden proposed the theory of free radical damage inflicting cellular harm and exceeding the antioxidant protection mechanism in these patients. Subsequently numerous studies have demonstrated that children with kwashiorkor had greater concentrations of biomarkers of oxidative stress and decrease ranges of antioxidants than marasmus and regular wholesome controls. The ranges of oxidative stress showed normalization after recovery from kwashiorkor. Thus, etiopathogenesis of kwashiorkor could be multifactorial in origin and single issue will not be answerable for the causation of disease. Marasmic kids have the very best total body water and decreased adipose and lean body mass. Dilutional hyponatremia can occur in kids with fluid retention or acute kidney damage following acute gastroenteritis. Protein binding of a number of the drugs is decreased and consequently there could be free drug ranges in plasma. Inadequate production of beta-lipoproteins results an impaired transport of fat from liver leading to fats accumulation in liver and fatty liver. Development of edema in kwashiorkor is multifactorial in origin and is as a end result of of low albumin stage, free radical damage and insufficient inactivation of antidiuretic hormone by liver resulting in water retention. There is more extracellular fluid than intracellular fluid and is found particularly Coexisting Nutrient Deficiencies Multiple coexisting nutrient deficiencies could be current because of decreased intake, malabsorption and losses in recurrent or persistent diarrhea. Nutrients like iron, zinc 892 and vitamins such as riboflavin, folic acid, vitamin B12, C and A could be affected in severe undernutrition and may present their clinical signs and signs of deficiencies. Endocrine System Endocrine glands play a serious function in the strategy of adaptation in response to stress to protein and calorie deficiency. Almost a lot of the major hormones are affected in youngsters affected by continual undernutrition. Delayed hypersensitivity reaction to purified protein spinoff is impaired in severe undernutrition. There is defective phagocytosis and the typical options of infection similar to leukocytosis and fever are absent. This hormone plays a significant position in adaptation to protein and calorie deficiency in these children. But its stage is found to be increased when complicated by an infection, acidosis, hypoglycemia and hypothermia. Plasma aldosterone level is regular but price of secretion is increased in marasmus. In distinction, its stage is elevated in kwashiorkor regardless of normal secretion fee and this is because of decreased metabolism by liver. There is atrophy of pancreas and small intestinal mucosa and total digestive enzymes are decreased. Villus atrophy of jejunal mucosa not only affects the vitamins but in addition drug absorption. Liver biopsy exhibits fatty changes, irregular rough endoplasmic reticulum and mitochondria and decreased peroxisomes. There is decreased gluconeogenesis leading to to high incidence of hypoglycemia particularly during stress such as an infection. Insulin There are adjustments in islets of Langerhans cells of pancreas in persistent undernutrition. Insulin degree is low in kwashiorkor and decreased response to intravenous glucose or glucagon is found. The impaired glucose tolerance may be as a result of poor insulin release in response to stimulus, insufficient utilization by peripheral tissues, decreased potassium and deficient food regimen in chromium. The defect in insulin launch might be due to either structural injury to beta cell by undernutrition or faulty stimulation of insulin release. Glucagon ranges have been found to be variable relying upon the involvement of alpha cells. Central Nervous System the undernutrition at an early age has essential impact on the creating mind. The dendritic arborization and morphology of the dendritic spines in addition to myelination are affected. Computerized tomography and magnetic resonance imaging of brain have proven options of cerebral atrophy in children suffering from undernutrition. This impacts the higher brain features and should lead to everlasting neuropsychological harm. Cognitive perform and learning skills stay affected even after dietary rehabilitation.
Important elements of communication and language expertise such as vocalization xerostomia medications side effects purchase lariam 250mg, gestures are apparent at this age. Observation of the Child A careful physical and developmental examination have to be carried out at each well-baby clinic visit. Presence of Risk and Protective Factors Assessment of risk factors is a crucial side of surveillance. The presence of multiple danger issue could improve the probabilities of developmental delay. Children with recognized danger elements could require extra frequent developmental surveillance or may be immediately referred for developmental assessment. Hence, screening tests have to be used to improve the precision in prognosis of developmental delay. The danger elements may be biological or environmental, or there could additionally be an overlap of both. Besides monitoring the growth and diet, a developmental examination no much less than in every 3 month this is really helpful. Hence, the pediatrician should do an excellent developmental examination, especially of the motor skills. Children with elevated tone might attain motor milestones early, asymmetrically or out of order like standing before sitting or improvement of handedness earlier than 18 months. Children who present regression of milestones should be investigated for neurodegenerative problems. The environmental danger components are low socioeconomic standing, poor maternal training and a single parent. Is there anything your baby used to be able to do that she or he can now not do? Screening instruments like ages and phases questionnaire could be accomplished by moderately educated dad and mom and the answers can be scored even by a non-physician. If we anticipate the child to miss a serious milestone like walking or speaking, it may be too late and we shall be depriving the child of the advantages of early intervention. Development and Developmental Delay Screening Test Results If the screening take a look at outcomes are regular, this may be advised to the mother and father and relieve them of their anxiousness. This analysis aims at making a selected analysis of the event disorder, for counseling the dad and mom relating to prognosis and referring the child immediately for correct therapeutic intervention. These children might have other related developmental and behavioral problems and these may even need to be handled. An interdisciplinary group consisting of a psychologist, occupational therapist and audiologist might be needed. Medical Evaluation A medical analysis consisting of organic, environmental and other threat elements for delayed improvement should be done in an try to establish an etiology. Screening of vision and hearing, review of neonatal metabolic display screen, growth, family and social historical past might give a clue to the etiology. A detailed medical evaluation and additional checks like brain imaging, electroencephalogram, metabolic screen and genetic display screen may be required. Thisalso helps in treatment, planning, genetic counseling for recurrence and prognosis. This evaluation could be done by a skilled and skilled pediatrician, a developmental pediatrician, pediatric neurologist and, if required, a pediatric geneticist. When a toddler is recognized as having developmental delay, early intervention is necessary. Involuntary movements or coordination impairments Regression of skill Developmental Disorder the kid may be referred for applicable remedy if a developmental dysfunction is recognized. Referral to Rehabilitation Services When a child is identified to have developmental delay, the child ought to be referred to a center which has specialised services. Intervention is most necessary when it happens at the time that a developmental skill should be emerging. The growth of preterm infants is quite different and has extra variability compared to full time period infants. It is essential to understand the deviations within the improvement of preterm toddler lest you make a rash prognosis of cerebral palsy. However, the brain has super plasticity, and by 9 months, many of those tone abnormalities disappear and tone normalizes by 1 12 months. This is why one should by no means make a diagnosis of cerebral palsy at the first examination, but a number of sequential examinations ought to be accomplished over a interval time. The waxing and waning sample of neuromotor improvement from 28 weeks to the top of first 12 months must be clearly understood. For instance, from 28 weeks to forty weeks of gestation, the acquisition of muscle tone and motor function spreads from the lower extremities to the head (caudocephalic). Neurosensory improvement is assessed by noting visible pursuit with a purple ball and listening to with a bell. History of convulsions, sleeping sample, high quality of cry and sucking and swallowing conduct should be noted. The angles are the same as these used in the Dubowitz gestational age rating, like the adductor angle, popliteal angle, scarf signal, square window, and so forth. These angles have been standardized by us on regular Maharashtrian infants and are quite just like those described for Caucasian French infants. Active tone is studied with the toddler moving spontaneously in response to a given stimulus like pull to sit or pull to stand. While eliciting ankle clonus, one must search for Achilles tendon tightness as a outcome of this can make the kid do toe-walking. The look of postural reactions like lateral propping and parachute on the proper age can also be famous. It is an effective screening check to identify infants who want occupational therapy and to decide which infants need to be referred for the more elaborate developmental checks. It imparts an understanding of the pathogenesis to the household, answering their need to know why. Trivandrum Development Screening Test this test can be utilized in the first 2 years of life. The range for each take a look at item was taken from the Indian adaptation of Bayley Scales of InfantDevelopment(BarodaNorms)Test. But it has been criticized for being unreliable in predicting less extreme or particular problems in children, leading to underreferals. Developmental Assessment Scale for Indian Infants the Bayley scale was standardized by Phatak for Indian infants. The take a look at have to be administered by a skilled psychologist, it needs a particular package and should be ideally carried out in a soundproof room. According to the American Academy of Pediatrics, each youngster attending the well-baby clinic should have a developmental examination at 9, 18 and 30 months. When a child is recognized to have developmental delay, early intervention is mandatory. The baby with developmental delay should be referred to a center which has specialized providers with multidisciplinary group. It covers 5 domains-language, cognitive, fantastic and gross motor and socioemotional. It takes half-hour administration time for children under thirteen months and 50 minutes for children thirteen months and above. This take a look at has been criticized because it yields higher than anticipated scores which can lead to underreferrals. Early identification of youngsters with developmental delays or disabilities can lead to early intervention and remedy and lessen its impression on the kid. The pediatrician must be expert in the utilization of screening methods, fastidiously listen to parental considerations, and create links with obtainable resources in the neighborhood. A three-center randomized, managed trial of individualized developmental take care of very low birthweight preterm infants: medical, neurodevelopmental, parenting and caregiving results. Transient tone abnormalities in "high danger" infants and cognitive end result at five years. Neurodevelopmental assessment within the first 12 months with emphasis on evolution of tone.
Some of the psychological problems associated with hearing impairment are behavioral issues medications like zoloft cheap lariam 250 mg visa, low vanity, despair and introversion. Behavioral issues like aggression or hyperactivity are as a result of inside points like depression, nervousness and lack of ability to talk. Children with listening to loss who begin intervention earlier have significantly better developmental outcomes than similar kids who start intervention later. Research shows that kids recognized with listening to loss receiving intervention before 6 months of age obtain listening to and speech expertise similar to their normal friends. Learning to hear is time-bound as the baby has a limited window to meet up with the conventional hearing friends, i. Early detection of hearing loss is essential to make certain that hearing impaired youngsters get equal opportunities as their normal hearing peers. Without such applications, the typical age of diagnosis of hearing impairment is 24 months, leading to vital delays in speech language, social, cognitive and emotional development. In utero infections, similar to cytomegalovirus, herpes, rubella, syphilis and toxoplasmosis auditory and communication expertise. Detailed historical past taking with particular give consideration to the high-risk elements, antenatal and perinatal particulars, consanguinity, historical past of hearing impairment in another members of the family and history of any severe sickness requiring hospitalization and administration of intravenous medication. Evaluation of the developmental age of the child by a developmental pediatrician and a child psychologist to rule out global developmental delays and search for other related issues, like autism, studying disabilities and behavioral issues. Complete assessment by a speech and language pathologist concerning the communicative abilities of the child. Craniofacial anomalies, including people who contain the pinna, ear canal, ear tags, ear pits and temporal bone anomalies 6. Physical findings, such as white forelock, which are associated with a syndrome identified to embody a sensorineural or everlasting conductive hearing loss 7. Neurodegenerative issues, similar to Hunter syndrome, or sensory motor neuropathies, such as Friedreich ataxia and Charcot-Marie-Tooth syndrome 9. Culture-positive postnatal infections related to sensorineural listening to loss, together with confirmed bacterial and viral (especially herpes viruses and varicella) meningitis 10. Those who fail the preliminary screening ought to undergo detailed audiologic analysis by three months of age and intervention carried out notlaterthan6monthsofage. An important point is that to be considered as pass, each the ears must cross screening. High-risk babies and neonatal intensive care unit graduates have a high incidence of auditory neuropathy and delayed onset or progressive listening to loss which needs to be continually monitored. The alternative of auditory prosthesis is dependent on the degree of hearing loss and the etiology. Bone Conduction Hearing Aid these are indicated for youngsters with conductive or mixed loss as a end result of abnormalities within the external or center ear not amenable to ear surgery. Hearing Aids Children with delicate to average hearing loss benefit from appropriately fitted hearing aids. It is recommended to fit listening to aids in both the ears of kids with listening to impairment to give them the benefit of binaural listening to. Cochlear Implants these are a confirmed option for children with bilateral extreme to profound listening to loss. A cochlear implant consists of an inner part which is surgically inserted and an external half which looks like a hearing assist. The expertise converts acoustic signals to electrical alerts and directly stimulates the surviving spiral ganglion cells in the cochlea. Tillrecently absence of the cochlear nerve was an absolute contraindication, nevertheless, sure studies are showing restricted advantages with the cochlear implants in this subgroup of sufferers. These require great warning on the a half of the surgeon as a result of the chance to the facial nerve in instances with aural atresia. Auditory Brain Stem Implants It is a device which offers some degree of listening to in folks with no functioning cochlear nerve. Early detection and intervention ensure development of near normal speech and language for youngsters with hearing impairment. Diagnostic audiology must be supplied by an audiologist with expertise in the evaluation of neonates and young youngsters. A sensitive period for the development of the central auditory system in kids with cochlear implants: implications for age of implantation. Cerebral palsy is a medical phenotype of varied sorts and degrees of motor impairment as a result of heterogenous causes, leading to a permanent single-time insult to the growing mind. Over the years, research have either proven a static trend or a minor increase in all probability reflecting elevated survival of very untimely babies. In developing countries, although antenatal causes are maximal, the proportion of acquired causes is relatively extra in distinction to developed international locations. Compared with the outcomes of an earlier research instances associated with prematurity, low birthweight, neonatal jaundice and start asphyxia had elevated considerably. Any important ischemic-hypoxemic insult triggers an excitooxidative cascade that causes secondary vitality failure within the mitochondria. Hypoperfusion provokes protecting redistribution of blood to the brain, coronary heart and adrenals. This ionic imbalance causes neuronal membrane depolarization and glutamate transporter failure in the presynaptic glia that normally removes glutamate from the synaptic cleft. Enzyme-mediated mobile injury and release of proapoptotic cytochrome C and apoptosis-inducing elements stimulate pathways resulting in neuronal apoptois. The cumulative impact is apoptosis and necrosis of mind cells with glia being more susceptible than neurons. The inflammatory cascade is triggered by maternal infection and makes the brain extra delicate to hypoxemic-ischemic damage. The most typical post-mortem findings in the premature mind are subependymal, intraventricular or leptomeningeal hemorrhage. A multiaxial classification essential for holistic understanding and applicable management will be mentioned later in this chapter. Abnormal gait Crouched (hip flexion, knee flexion and ankle dorsiflexion) and circumductive. The lower limbs exhibit equinovalgus, equinovarus and pes valgus, flexion of the knees and hip subluxation (characterized by pelvic obliquity). Abnormal reflexes Hyperreflexia of deep tendon reflexes, persistence of neonatal reflexes, persistent extensor plantar reflexes and failure of look of postural reflexes. This will get confounded by sensory impairments and motor restriction which result in restricted cognitive stimulation and experiential learning. They may be as a result of main defects, drug unwanted effects or faulty parenting practices. Speech and language problems these arise because of cognitive defects, hearing impairment or dysfunctional speech areas. Sensory impairment these embody cortical blindness, listening to impairment, perceptual deficits oromotor hypersensitivity and sensory disintegrative dysfunction. Ocular manifestation these embrace strabismus, refractory errors, optic atrophy, nystagmus and visible impairment. Source: Reproduced with permission from Ann-Christin Eliasson and Peter Rosenbaum, Can Child Centre for Childhood Disability Research, Ontario. Manifestations in Evolving Cerebral Palsy Recognition of this stage requires experience, keen remark and scientific acumen. Parents must be sensitively explained that the delicate abnormalities detected could also be a false alarm but nonetheless would require intervention and close follow-up for a couple of months. Macronutrient and micronutrient deficiencies that is attributable to decreased consumption. Vitamin D deficiency is due to nonambulation, anticonvulsants, low solar publicity and poor calcium consumption. Secondary abnormalities: Spasticity leads to disuse atrophy, joint contractures and limb size discrepancy. Deformities like femoral anteversion, external tibial torsion, talipes equinovalgus and hip subluxation are referred to as lever arm disease because of a malaligned bony lever that impairs muscle function and affects gait.
Fast meals are high in energy inoar hair treatment buy lariam 250 mg with visa, fat and sodium however fail to provide sufficient nutritional vitamins and minerals wanted throughout this stage. Very little information is available in regards to the nutrient composition of quick foods. Food components like ajinomoto and coloring agents used for preparation of fast meals are antinutrients. Peer pressure, media influence and rapid modifications in the body dimension and shape may make them uncomfortable about their our bodies. In some families, adolescent girls eat final and least due to ignorance and poverty. Psychological problems and consuming disorders like anorexia nervosa and bulimia can also intrude with sufficient diet. Dietary experimentation within the type of strict vegetarianism with out proper data about the wholesome meal plans may result in malnutrition. In addition to consumption of a nutritious nicely balanced diet, applicable way of life practices and involvement in bodily activity such as video games or sports ought to be inspired amongst children and adolescents. The immune response could additionally be IgE mediated, non-IgE mediated or a mix of both. Food intolerance is a nonimmune reaction that occurs after ingestion of meals due to metabolic, poisonous, pharmacologic or undefined mechanisms. Allergy to milk, egg, soy, or wheat is more more likely to be outgrown than allergy to tree nuts or peanut. Food allergens may cause signs when eaten both within the uncooked kind or after being cooked. Cross reactivity can happen between totally different allergens which have structural similarity. IgE-mediated reactions are characterised by an acute onset of symptoms generally within 2 hours after ingestion of the set off meals. IgE-mediated reactions to meals typically contain the skin, gastrointestinal tract, and respiratory tract. Exposure to the allergen will stimulate the Th2 lymphocytes, which will stimulate the B-cells to differentiate into plasma cells and produce allergen specific IgE antibodies. Once the allergen specific antibodies have bound to the mast cells, the patient is taken into account as sensitized to that allergen. On re-exposure to the meals, antigenic proteins in the food bind to and cross-link the IgE antibodies on the mast cells, which trigger the discharge of symptom-causing mediators, similar to histamine and leukotrienes. An IgE-mediated food allergy requires both the presence of sensitization and the development of particular indicators and signs on publicity to that meals. These situations primarily affect infants or younger children who present with abdominal complaints, corresponding to vomiting, stomach cramps, diarrhea, and occasionally blood in the stool and failure to thrive or poor weight achieve. Examples of food allergy with combined IgE- and non-IgE-mediated causes embody eosinophilic esophagitis and atopic dermatitis. Source: Dr Rimjhim Shrivastava, Pediatric Gastroenterologist, Raipur, Chhattisgarh. Treatment Clinical Features Allergic reactions occur if the precise IgE is above a crucial level. Symptoms of IgE-mediated meals allergy can happen within minutes to hours of ingesting the set off food and can range in severity from mild to life-threatening. Severity of allergic reactions varies primarily based on the amount of meals ingested, preparation of the meals and ingestion of other foods together with the set off food. The rate of absorption increases if the food was eaten on empty stomach or near the time of train, leading to a more extreme reaction. Food induced anaphylaxis is a extreme allergic reaction as a end result of systemic launch of mediators. Non-IgE mediated meals allergy syndromes current predominantly with abdominal symptoms. The safest remedy for food allergy is strict avoidance of the causal meals or foods. This holds good for all food allergy syndromes regardless of the mechanism of allergy. Patients ought to be educated on how to read ingredient labels on the food items to keep away from their allergens.
[newline]In many western international locations, food-labeling legal guidelines require food manufacturers to declare in plain language on the meals packaging whether one of many widespread allergens or a product derived from them is used as an ingredient. Prognosis As age advances most children will be in a position to tolerate beforehand allergic meals. This is due to maturation of the gastrointestinal barrier system and growth of immunological tolerance. Diagnosis Specific IgE could be demonstrated by constructive allergic skin prick test or immunoassay of serum. Include cereal pulse combination, roots and tubers in adequate quantities, vegetables and fruits liberally, milk, milk products and meat sparsely and oils, fats and sugars sparingly. Vegetarians have low-risk of weight problems, hypertension, coronary arterial illness and colon cancer. Lacto-ovo-vegetarians have very little nutritional threat except iron deficiency as a outcome of lack of heme iron. Fruitarians who eat solely fruits are at the threat of protein, sodium, calcium and different mineral deficiency. Micronutrients and antioxidants together with beta-carotene, vitamin A, vitamin C, folic acid, iron, iodine and zinc are essential for healthy life. Nutrient Requirements and Recommended Dietary Allowances for Indians - Report of the Expert Group of the Indian Council of Medical Research. Traditional dietary fads can also hinder intake, absorption, or utilization of micronutrient wealthy foods. Cereal-pulse based Indian diets are qualitatively deficient in iron, calcium, vitamin A, riboflavin and folic acid, as a end result of low consumption of green leafy greens, fruits, and foods of animal origin. For the nation, it interprets into loss of economic productivity, and hike in investment on well being and education. Early onset of malnutrition can even have lasting effects on progress and long-term useful standing. Moderate and delicate undernutrition may remain unrecognized as a result of clinical criteria for his or her analysis are imprecise and difficult to interpret precisely. Micronutrient malnutrition continues to affect over 2000 million individuals worldwide. It is difficult to assess the true burden of micronutrient malnutrition because it requires laboratory amenities, advanced technology and other sources. The population India There has been a major decline in the prevalence of severe protein vitality malnutrition in India, over past few decades. Statewise state of affairs Malnutrition varies broadly across region, states, age, gender and social teams, being worst in kids beneath two, in the populous northern states, in rural areas, and among tribal populations and scheduled castes. The dietary status of kids can be strongly related to maternal dietary status. Undernutrition is extra widespread for children of moms whose physique mass index is beneath 18. Malnourished mothers have a excessive incidence of low birthweight and growth retarded babies with poor dietary reserve. Lack of exclusive breastfeeding for first 6 months makes the child prone to early onset malnutrition. Artificial feeding is usually disastrous for the infant due to the poor high quality of the substitute milk, excessive dilution and use of unhygienic feeding bottles and nipples. High pressure advertising by baby meals manufacturers and social demands on the urban educated working ladies has inspired early discontinuation of breastfeeding. Poor moms are probably to economize on their use and provide diluted milk formulation to the infant. Unhygienic feeding practices within the preparation of milk formula end in frequent episodes of diarrhea and diminished absorption of food by the toddler. In most rural households, introduction of semisolid foods is delayed, typically past one 12 months. Diarrhea, pneumonia, malaria, measles, whooping cough, and tuberculosis precipitate acute malnutrition and worsen the present nutritional deficit. Also, malnutrition may adversely have an effect on the immune status and make the malnourished people extra susceptible to infections.
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