Management of the severely malnourished child: perspective from developing countries

In the 1990s, the number of underweight children in developing countries declined from 177 million to 149 million.1 The incidence of severe malnutrition also declined but, despite this, severe malnutrition remains an important problem (fig 1). 2 3 In India, for example, 2.8% of children under 5 are severely wasted.3 Malnutrition is a contributing factor in nearly 60% of deaths in children for which infectious disease is an underlying cause.4 Malnutrition is also linked to an increased risk of death in children with diarrhoea and acute infections of the lower respiratory system and it may be linked to malaria—and possibly measles—too.5

Death rates caused by severe malnutrition have changed little over the past few decades in hospitals of developing countries (median 23.5% during the 1990s) because malnutrition was inappropriately managed.6 Recent studies from Bangladesh and Brazil, however, have reported a substantial decline in case fatality after the adoption of new treatment protocols by hospitals. 7 8 This review describes the new treatment regimens that have been introduced and the evidence that justifies their use.9