ensuring they are equipped with the proper education and resources, caretakers and infants are in better health, ultimately preventing childhood malnutrition. because edema can hide decreased muscle mass, it can be hard to diagnose kwashiorkor in young children; however, if cases are overlooked, children become more susceptible to infections and can ultimately lead to morbidity and mortality. to prevent this from happening, parents can be educated on proper nutrition and the importance of breastfeeding infants to ensure they receive all the nutrients they need. a diet rich in carbohydrates, fats that make up 10% of the total caloric needs, and proteins that make up 15% of the caloric needs can prevent kwashiorkor. proteins can be found in the following foods seafood peas nuts seeds eggs lean meat beans treatment who guidelines outline 10 general principles for the inpatient management of severely malnourished children. treat/prevent hypoglycemia treat/prevent hypothermia treat/prevent dehydration correct electrolyte imbalance treat/prevent infection correct micronutrient deficiencies start cautious feeding achieve catch-up growth provide sensory stimulation and emotional support prepare for follow-up after recovery both clinical subtypes of severe acute malnutrition (kwashiorkor and marasmus) are treated similarly. upon initial treatment, children with kwashiorkor may experience weight loss as their edema resolves. therefore, after concerns of refeeding syndrome have passed, children may require 120-140% of their estimated caloric needs in order to achieve catch-up growth. the cause, type, and severity of malnutrition determines what type of treatment would be most appropriate. for primary acute malnutrition, children with no complications are treated at home and are encouraged to either continue breastfeeding (for infants) or start using ready-to-use therapeutic foods (for children). for secondary acute malnutrition, the underlying cause needs to be identified to appropriately treat children. only after the primary disease is determined can an appropriate dietary plan be made, as fluid, vitamins, and macronutrients may need to be considered to not exacerbate the cause of the malnutrition. ready-to-use therapeutic foods (rutfs) and f-75 and f-100 milks were created to provide appropriate nutrition and caloric intake to those experiencing malnutrition. f-75 milk would be ideal when trying to reintroduce food into a malnourished person, and f-100 milk would be used to aid in weight gain. while rutfs and f-100 milk were made to have the same nutritional value, rutfs are beneficial as they are dehydrated and do not require much preparation. prognosis kwashiorkor is associated with a high risk of mortality and long-term complications. treatment under the guidelines of the world health organization has proven to reduce this mortality risk and affected children tend to recover faster than children with other severe malnutrition diseases. however, physical and intellectual capabilities are not fully restored. growth stunting and chronic disruption of microbiota are commonly observed after recovery. a high risk of death is identified by a brachial perimeter < 11 cm or by a weight-for-age threshold < −3 z-scores below the median of the who child growth standards. in practice, malnourished children with edema are suffering from potentially life-threatening severe malnutrition. epidemiology kwashiorkor is rare in high income countries. it is mostly observed in low-income and middle income nations and regions such as southeast asia, central america, congo, ethiopia, puerto rico, jamaica, south africa, and uganda, where poverty is prominent. occurrences of severe malnutrition also tend to trend higher under conditions of food insecurity, higher prevalence of infectious diseases, lack of access to appropriate care, and poor living situations with inadequate sanitation. communities experiencing famine are affected the most especially during the rainy season. prevalence varies, but it affects children of either sex commonly under five years old. "globally, kwashiorkor indirected accounted for 53% of deaths among children under five between 2000 and 2003 when associated with other common childhood diseases like acute respiratory infections, malaria, measles, hiv/aids and other causes of perinatal deaths." when compared to marasmus in developing countries, kwashiorkor typically has a lower prevalence, "0.2%-1.6% for kwashiorkor and 1.2%-6.8% for marasmus." factors such as "diet, geographical locations, climate and aflatoxin exposure" have been invoked as potential causes for observed differences in the prevalence for kwashiorkor and marasmus. in general, in areas where severe acute malnutrition (sam) is prevalent, marasmus is more often the dominant sam condition. however, in certain areas kwashiorkor may be more common than marasmus. history kwashiorkor was present in the world long before 1933, when cecily williams published research which took the ga name for the disease. there were already many names for the illness which referenced the cessation of breastfeeding, or the consumption of monotonous diets high in starch. however, williams was the first to suggest that this might be a deficiency of protein or an amino acid. despite publishing in 1933, it was only in 1949 that the world health organization officially recognized kwashiorkor as a public health concern. this period also correlated with the promotion of infant formula, often by european colonial powers. the substitution of formula for breastmilk contributed significantly to the increasing visibility of kwashiorkor throughout the twentieth century. cicely williams later described the promotion of formula as "the most criminal form of sedition, and that those deaths should be regarded as murder." these arguments underpinned the 1970s nestlé boycott. effects on pharmacokinetics those experiencing poverty-related infectious diseases (prds) such as malaria and tuberculosis are also likely to be malnourished. malnutrition can affect the pharmacokinetics of various drugs used to treat prds by changing a drug's bioavailability, distribution, and elimination. to optimize treatment of those diseases, there needs to be more research into how severe malnutrition, specifically kwashiorkor, can affect treatment response. research directions current research and recommendations to manage severe acute malnutrition (sam), such as kwashiorkor, in children are largely based on expert opinions. only one-third of the who guidelines for management of sam are based on epidemiological and clinical research. further studies are needed in order to "improve treatment outcomes in the large number of children with sam."