Aims Severe acute malnutrition (SAM) causes over 1 million under-5 child deaths in developing countries each year. Among those at risk are children with disabilities. Because their growth often differs from that of non-disabled peers, they are often excluded from SAM-related studies. Little data is therefore available on their outcomes from SAM. We aimed to address this gap by describing:

• ▶ Prevalence of disability among a cohort of children with SAM

• ▶ Short and long term outcomes among disabled children with SAM.

Methods Secondary data analysis. All children admitted to an urban nutrition rehabilitation unit in Malawi between July 2006 and March 2007 were monitored and followed-up at 1 year post discharge.

Results Of 1024 children, 60 (5.9%) had an obvious disability: most commonly developmental delay or cerebral palsy (46/60, 77%). Multivariable logistic regression incorporating age, sex, admission anthropometry, oedema and HIV status showed that disabled children were significantly less likely to be HIV positive (p<0.001) and more likely to have a weight-for-height Z score of <−3 (p=0.047).

Disabled children were significantly more likely to die in the first 90 days of treatment (hazard ratio 2.29, 95% CI 1.36-3.85, p=0.002 and also more likely to die in the longer term (HR 2.29, 95% CI 1.51-3.45, p<0.001).

Conclusions Our data suggest that children with disability are a particularly vulnerable SAM subgroup, with high risk of mortality both short and long term. It is important to recognise that there may be many modifiable factors underlying this observation: it is unlikely explained by greater physiological vulnerability alone. Social factors might include suboptimal care practices at home and in communities which increase the risk of a disabled child developing SAM; delayed presentation to care when problems do arise; suboptimal post-SAM care. Treatment services also need to be more proactive about their approach to disability. Protocols should recognise and offer guidance to help identify and care for children with disability. This might include closer referral linkages with disability support services. Finally, more research focusing on this group is needed to determine how treatments might be improved and better tailored to those with underlying disability.