Marasmus a severe form of emaciation and wasting in an infant due to malnutrition. This disorder is common in Bangladesh among the poor rural children aged less than two years. Inadequate food intake, malabsorption of nutrients, and consequent caloric deficiency are the causes of this disorder.

Symptoms of marasmus include extreme weakness, and failure to gain weight, followed by loss of weight. No edema or hepatic enlargement. Brain and skeletal growth continues resulting in a long skinny body and a large head in proportion to weight. Subcutaneous fat is minimal, eyes become sunken and the skin appears loose. The infant is not active, muscles are flabby and relaxed showing gross wasting. The cry is weak and shrill.

Death occurs in about 40% of the affected children. In 1995, the government launched the Bangladesh Integrated Nutrition Project (BINP), with support from the World Bank and UNICEF. The project, one of the major large-scale nutrition programme operating in developing countries worldwide, has reached more than three million households in Bangladesh. It is best known for its community-based approach and provides nutrition survices, child growth monitoring, nutrition counselling and food supplementation to severely affected children under the age of two. Nutrition services are offered at the local level through community nutrition centres, donated and managed by village committees.

In 1998, an evaluation and review of the project revealed that severe malnutrition among children less than two years old in the project area had declined from the baseline figure of 13 percent to two percent. It is expected that the pilot project would expand and the services would reach to all rural areas of country within the next 15 years.

To prevent marasmus, nutritional rehabilitation along with mothers' education and family planning are primary essentials. Mothers be encouraged breast-feeding and to keep contact with the maternity and child health clinics. [SM Humayun Kabir]