Severe Acute Malnutrition

Severe acute malnutrition (SAM) is a life-threatening form of undernutrition in children, characterised by severe wasting and/or nutritional oedema. It requires prompt identification and structured management, as it carries a high risk of death if untreated.

• Visible severe wasting
• Mid-upper arm circumference (MUAC) below 11.5 cm in children aged 6–59 months
• Bilateral pitting oedema of the feet (oedematous malnutrition/kwashiorkor)
• Weight-for-height/length below -3 standard deviations
• Thin, sparse hair and skin changes
• In severe cases: signs of shock, hypoglycaemia, or hypothermia

• Inadequate dietary intake.
• Frequent or prolonged illness, such as diarrhoea, pneumonia, HIV, or tuberculosis.
• Poor infant and young child feeding practices.
• Food insecurity and underlying poverty.
• Malnutrition and infection often worsen each other in a repeating cycle.

• Identified through mid-upper arm circumference (MUAC) measurement and checking for bilateral pitting oedema.
• Weight-for-height/length is assessed against WHO growth standards.
• Children are further classified as having medical complications, feeding difficulty, or grade 3 oedema requiring inpatient care, or as uncomplicated cases suitable for outpatient management.

Children with severe acute malnutrition and medical complications are admitted for inpatient stabilisation, including cautious feeding with therapeutic milk formula (F-75) during the initial stabilisation phase, treatment of hypoglycaemia, hypothermia, dehydration, and infection, and correction of micronutrient deficiencies.

Once stable, children transition to ready-to-use therapeutic food (RUTF) and are managed as outpatients with weekly follow-up until recovery.

Children without complications who are able to eat are managed directly as outpatients with RUTF and routine medicines — antibiotics, vitamin A, deworming, and folic acid — according to protocol.

• Promote exclusive breastfeeding for the first six months, with continued breastfeeding and appropriate complementary feeding thereafter.
• Attend regular growth monitoring.
• Seek prompt treatment for childhood illnesses.
• Support community-based screening using MUAC tapes.
• Address household food security.