Arch Dis Child 92:453-461 doi:10.1136/adc.2006.098327
  • Global child health

Treating severe acute malnutrition seriously

  1. Steve Collins
  1. Correspondence to:
    Steve Collins
    Centre for International Health and Development and Valid International Ltd, Unit 14 Standingford House, 26 Cave Street, Oxford OX4 1BA, UK; steve{at}
  • Accepted 15 September 2006


Severe acute malnutrition (SAM) affects approximately 13 million children under the age of 5 and is associated with 1–2 million preventable child deaths each year. In most developing countries, case fatality rates (CFRs) in hospitals treating SAM remain at 20–30% and few of those requiring care actually access treatment. Recently, community-based therapeutic care (CTC) programmes treating most cases of SAM solely as outpatients have dramatically reduced CFRs and increased the numbers receiving care. CTC uses ready-to-use therapeutic foods and aims to increase access to services, promoting early presentation and compliance, thereby increasing coverage and recovery rates. Initial data indicate that this combination of centre-based and community-based care is cost effective and should be integrated into mainstream child survival programmes.


  • Funding: This work was supported by funding from Concern Worldwide. Concern Worldwide has been engaged in the research and development of community-based therapeutic care but has had no influence over the text of this review.

  • Competing interests: The author works for Valid International Ltd, an organisation that has been engaged in the research and development of community-based therapeutic care. He is also an unpaid director of Valid Nutrition, a not-for-profit company established to research and manufacture ready-to-use therapeutic food in developing countries.