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Management of severe acute malnutrition in low-income and middle-income countries
  1. Indi Trehan1,2,
  2. Mark J Manary1,3,4
  1. 1Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
  2. 2Department of Paediatrics and Child Health, University of Malawi, Blantyre, Malawi
  3. 3Department of Community Health, University of Malawi, Blantyre, Malawi
  4. 4Children's Nutrition Research Center, Baylor College of Medicine, Houston, USA
  1. Correspondence to Professor Mark Manary, Department of Pediatrics, One Children's Place, Campus Box 8116, St. Louis, MO 63110, USA; manary{at}


Kwashiorkor and marasmus, collectively termed severe acute malnutrition (SAM), account for at least 10% of all deaths among children under 5 years of age worldwide, virtually all of them in low-income and middle-income countries. A number of risk factors, including seasonal food insecurity, environmental enteropathy, poor complementary feeding practices, and chronic and acute infections, contribute to the development of SAM. Careful anthropometry is key to making an accurate diagnosis of SAM and can be performed by village health workers or even laypeople in rural areas. The majority of children can be treated at home with ready-to-use therapeutic food under the community-based management of acute malnutrition model with recovery rates of approximately 90% under optimal conditions. A small percentage of children, often those with HIV, tuberculosis or other comorbidities, will still require inpatient therapy using fortified milk-based foods.

  • Nutrition
  • Comm Child Health
  • Tropical Paediatrics

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