One of the biggest challenges Grade 1 teachers in Australia face is keep up with the energy levels of their young students.

At Nammen Primary School in northern Laos, Grade 1 teacher Pim has the opposite problem.

Her students often come to school lethargic. Their young minds aren’t buzzing with enthusiasm. Instead, they are distracted by stomach pains and headaches.

Laos has some of the highest rates of child malnutrition in Asia. In many remote villages like Pim’s over half of all children are chronically malnourished and over a third are underweight.

Pim, who has been teaching at the government school for 13 years, sees firsthand the effect this has on children.

“My students often come to school hungry and when they are hungry they cannot concentrate, it is very hard to teach them,” she says.

Malnutrition locks children into a cycle of poverty.

When a child doesn’t get the food they need, their growth can become stunted, making them more vulnerable to disease.

Without proper nutrition, a child’s brain may not develop to its full cognitive ability. When children are repeatedly ill, their body can struggle to retain the nutrients of an already meager daily diet.

Repeated illnesses can affect their families, who may have to miss work or school to look after the child and spend more of their limited resources and income on medical care.

The majority of children who are stunted come from families living in poverty and who already under considerable financial stress.

Nutrition-related factors accounted for about 45% of all deaths of children under five in 2016. In Laos, every year more than 6,000 children die due to illnesses related to malnutrition.

For every undernourished child who survives, countless more are permanently affected. When stunted children become adults they can expect to earn 20% less than adults who were not stunted as children.

Thaimoua Yongvang, ChildFund Laos’ provincial area manager for the region that covers Nammen village, says this is one of the region’s biggest problems.

As a health worker in one of Laos’ remote northern villages, Ounkeo Xaythangded has seen too many children suffer because of a lack of food.

Ounkeo is the head of the mother-child and nutrition department at Nonghet District Hospital, the main health centre in a region that has some of the highest rates of malnutrition in Asia.

In her 14 years at the hospital, Ounkeo (pictured above) has seen many cases of children becoming sick and not developing properly because they are not getting the food they need.

“Children who do not get enough food are always sick,” she says. “They always have problems with their stomachs. They get fever. It takes longer to treat them compared to a healthy child. They are unhappy, they are always upset.”

The case that sticks in Ounkeo’s mind is a 20-month-old baby who died at home because she was not getting enough food.

The baby’s mother brought her to the hospital showing signs of malnutrition and Ounkeo and her staff helped treat her, but her mother kept returning.

“The child kept getting sick and coming to the hospital, before eventually dying at home,” Ounkeo says.

Every time a child dies it is a tragedy, but nutrition-related deaths are particularly tragic because they are preventable.

Laos has some of the highest rates of malnutrition in Asia. As many as three-quarters of children are unable to reach their physical, intellectual and productive potential.

They are underweight, wasting, or their growth is stunted. When a child does not get the right kind of nutrients early in life, the development of their brain and body can be permanently affected.

In Laos, children are born hungry. Malnutrition can start before birth.

Two in five pregnant women living in remote villages are malnourished, suffering from high rates of anaemia, due to a poor and unchanging diet.