Background information: Malnutrition is the cellular imbalance between supply of nutrients and energy and the body’s demand for them to ensure growth, maintenance, and specific functions (WHO malnutrition the global picture). Underweight means low weight for age according to WHO growth standard (GHO data). Severe acute malnutrition is defined by a very low W/H or W/I (below -3SD of the median WHO growth standards) or clinical signs of bilateral pitting edema, or a very low muac (less than 11.5cm). Edema is a swelling caused by the accumulation of fluid in the body tissues. Types of SAM are kwashiorkor where by diet may be sufficient to assuage hunger, but is usually grossly deficient in protein characteristics include edema which may be mild (bipedal) or severe (generalized), often associated with skin desquamation and hair changes also there is marasmus the main deficiency is energy or calories. It is a form of starvation (characteristics include emaciated appearance or wasting), lastly is marasmic kwashiorkor which has a combination of features of both types.

Women and young children are the most adversely affected groups; one quarter to one half of women of child bearing age in Africa and south Asia are underweight, which contributes to the number of low birth infants born annually. Malnutrition is globally the most important risk factors for illness and death, contributing to more than half of deaths in children worldwide. Child malnutrition was associated with 54% of deaths in children in developing countries in 2001. (Monika Blossner Mercedes de Onis 2005).

Malnutrition in under five children remains a major public health problem in Tanzania and sub-Saharan Africa in general. It causes significant morbidity worldwide, and especially in high-burden settings, such as sub-Saharan Africa. Complications of malnourished are due to lowered resistance to infections they are more likely to die from serious infections especially septicemia or pneumonia, gastroenteritis, TB, diarrhea and other respiratory infection other complication include hypoglycemia hypothermia dehydration, electrolyte imbalance, anemia and sudden death. Sudden death mostly secondary to dehydration and electrolyte imbalance (John Patrick British Journal April 1977).

Malnutrition contributes to more than 50% of death in children worldwide. It was associated with 54% of children death in developing countries in 2009 mostly in sub-Saharan African. Severe acute malnutrition affect an estimated 19 million children under 5 years of age worldwide and is estimated to account for approximately 400,000 child death each year (Elena WHO).

Tanzania is among African countries with the highest levels of malnutrition, the prevalence of malnutrition in Tanzania was around 42.5% among underfive. About a third of children aged 6 to 59 month are vitamin deficient (WB Tanzania report 2010).