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ARS Home » Plains Area » Houston, Texas » Children's Nutrition Research Center » Research » Publications at this Location » Publication #396230

Research Project: Microbiota and Nutritional Health

Location: Children's Nutrition Research Center

Title: Management of complicated severe acute malnutrition in children in resource-limited countries

item TREHAN, INDI - University Of Washington
item MANARY, MARK - Children'S Nutrition Research Center (CNRC)

Submitted to: UpToDate
Publication Type: Book / Chapter
Publication Acceptance Date: 1/2/2021
Publication Date: 6/7/2021
Citation: Trehan, I., Manary, M.J. 2021. Management of complicated severe acute malnutrition in children in resource-limited countries. UpToDate. Available at:

Interpretive Summary:

Technical Abstract: Severe acute malnutrition (SAM) is a pervasive problem throughout resource-limited ("developing") countries. Severely malnourished children are often identified when brought to medical attention for an acute issue, such as diarrhea or fever, but should also be sought through community-wide screenings of vulnerable children in high-risk settings. In some cases, SAM is precipitated by political disruptions like war or natural disasters like drought, which interfere with the food supply. However, more often, SAM is simply a disease of pervasive poverty and poor hygienic conditions, compounded by socioeconomic disparities, seasonal shortages of food, and spikes in illnesses such as malaria or infectious diarrhea. This topic review will discuss treatment of children with SAM with complications such as intercurrent infections. Affected children are treated as inpatients in hospitals or feeding centers, using protocols promoted by the World Health Organization (WHO). In the past, this approach was used for most children with SAM. However, experience over the last 15 to 20 years has demonstrated that children with uncomplicated SAM, constituting the vast majority of malnourished children, can and should be treated at home with support from outpatient feeding programs. This community-based management of acute malnutrition (CMAM) approach appears to produce equal or better recovery and case fatality rates, and to widen population coverage, and has been successfully implemented worldwide by governments and relief organizations. As a result, CMAM has become the international standard of care for uncomplicated cases of severe malnutrition.