Explain Two major causes of severe Protein Energy Malnutrition?

Two major causes of severe PEM are diluted milk formulae and infections, especially diarrhoea in poor communities living under unsanitary conditions. Severe PEM needs hospital intervention. The treatment is also, rehydration with ORS. When diarrhoea subsides, feeding at the rate of 3-4 g protein/kg BW and 170-200 Kcal/kg BW is initiated. Most hospitals use milk-based formulae. Dry skimmed milk (DSM) powder better tolerated but due to low energy content, the targets are difficult to meet.

A formulae containing 90 g dried skimmed milk (DSM) + 70 g sugar + 50 g vegetable oil in one litre water provides 100 Kcal and 3 g protein1100 ml. The children are given 100-150 m kg BW and the amount depends on how well it is tolerated. Sugar and oil amounts are increased, if more energy density is needed. Milk tolerance is indicated by watery diarrhoea in which case it should be substituted with cereal. Older children however accept solid foods. Oil is added to the mixed cereal-based diets to increase energy density in preschoolers suffering from PEM, Vitamin and mineral supplements are strongly recommended as PEM is always associated with multi vitamin and mineral deficiency.