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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}


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.

  • CFR, case fatality rate
  • CTC, community-based therapeutic care
  • IMCI, Integrated Management of Childhood Illness strategy
  • MoH, Ministry of Health
  • MUAC, middle upper arm circumference
  • NGO, non-governmental organisation
  • NRU, nutrition rehabilitation unit
  • OTP, outpatient treatment programme
  • RUTF, ready-to-use therapeutic food
  • SAM, severe acute malnutrition
  • SC, stabilisation centre
  • SFP, supplementary feeding programme
  • WFH, weight-for-height
  • acute malnutrition
  • CTC
  • SAM

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  • 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.

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