. L and environmental factors. Pnorfeccling practiccssuch as not exclusive ly breastfeeding for six moths, r<11,r reeding 1>rnctices (giving foods too early or 100 lalc) and giving foods whjch lack in <:ncrgy, protein and other essential nutrients from varied foocls are cnuscs of un<lcrnutrili <Jn. This is aggravated by frr. quenl infections because or poor cnvironnumt, inadcqu:1te access to health services, poor maternal and child care practices. The severe forms of malnutrilion are marasmus and kwashiorkor., Marasmus Marasmus results from prolonged starvation and is associated with severe wasting with classical signs of "old man's facie" because ofloss of fats in the cheeks. A child vii th marasrnus appears apathetic, with ilhfo, sparse and easily plucked hair. The child usually has good appetite. Kwashirokor The main sign of 1.-washiorkor is the presence of pitting edema in the legs and feet and can also affect the hands and face. The face is characterized as~rnoon face" likely rlne to edema, hair is described as flag-sign, because ·of alternating dcpcgmentation, the skin lesion called M{laky paint dermatosis". Children with kwashiorkor are also apathetkand irritable. Marasmic-Kwashiokor This is a. mixed form of PEM and manifests with edema bnt do not have the 0th. er signs of kvvasbiorkor. Management of PEM Children with severe PEM are at risk of hypoglycemia, hypothermia, dehydration, electrolyte in1balance, micronutrient deficiencies and infection. Thus, manageme nt of cases requires first, an initial stabilization for acute and medical conditions followed by a rehabilitation phase (WHO, 2000). 1. Treatment of dehydration, hypoglycemia, hypothermia and electrolyte imbalance 2. Treatment of infection 3. Vitnm. i n and mineral supplements to treat micronutrient deficiencies 4. Treat mcnt of other conditions 5. Initial feeding 6. Assessment of recovery To prevent and control malnutrition, ilie following are recommende d: ensure tl1at food that is adequate in quantity and quality, control infection through public health measures and proper nutrition education of mothers and caregivers (encourage breastfeeding, knowledge on appropriate foods for the young). 2. IRON DEFICIENCY ANEMIA Anemia is defined as low hemoglobin level. Nutritional anemia results when there is an inadequate store of a specific nutrient needed for hemoglobin synthesis. The most common causes of nutrition al anemia are: iron deficiency, folate deficiency and vitamin B12 deficiency. Iron deficiency is the most prevalenl micronub:ie nt deficiency worldwide and the most common cause ofnutrit:iona J anemia. Iron deficiency anemia is of major concern because it can affect various stages of life and have serious effects. Iron defkiency anemia results in decreased work performance since low hemoglobin level means low supply of oxygen needed by tissues to perform 341 