Determinants of severe acute malnutrition in children between six months to five year of age enrolled in nutritional rehabilitation centre at a tertiary care level


  • Gargi H. Pathak Department of Paediatrics, B.J. Medical College, Ahmedabad, Gujarat, India
  • Anuya V. Chauhan Department of Paediatrics, B.J. Medical College, Ahmedabad, Gujarat, India
  • Sunita O. Beniwal Department of Paediatrics, B.J. Medical College, Ahmedabad, Gujarat, India



Characteristics Determinants, Nutritional, Rehabilitation, Severe acute malnutrition, Socio-demographic, Tertiary care centre


Background: Indicators showing levels of nutritional status in children are often regarded as representative of the health and general well-being of a society at large. Malnutrition stands as a consequence of several key social and economic factors such as lack of education, inadequate health care services and ill-informed cultural behaviors.  In order to holistically address the issues surrounding malnutrition, a comprehensive understanding of the multi-dimensional complexities at play in society is crucial. Objective was to identify determinants of severe acute malnutrition among children with severe acute malnutrition under 5 years (between 6 months to 60 months) of age. Methods: A cross sectional study design involving 64 patients with severe acute malnutrition between 6 to 60 month of age was employed to identify the risk factors of severe acute malnutrition among children admitted in pediatric wards and nutritional rehabilitation centers, Civil hospital Ahmedabad, from April 2018 to march 2019. A detailed history of all the patients were taken and data collected using structured interviewer-administered questionnaire.

Results: Thus, from the above study, it is clear  that age of the child <2 years, female gender, bigger family size, poverty, illiteracy in mother, poor feeding practices, improper complementary feed introduction, poor nutritional status of mother whose child were breastfed, acute or chronic illness in child and narrow birth spacing were the chief determinants of SAM in under five children.

Conclusions: Socio demographic characters, nutrition and child caring practices, infection and other childhood illness as well as obstetric history of mother are important determinants of severe acute malnutrition in children under five years of age. As a result, collaborative efforts should be organized to improve promotion of better child caring practices through appropriate age specific child and maternal feeding practices, prevention and early treatment of acute childhood illnesses and promotion of family planning.


International Institute for Population Sciences (IIPS) and Macro International. National Family Health Survey (NFHS-3), 2005-06: India: Volume I. Mumbai: IIPS. Chapter 10.1; 2007:267. Available at: › pubs › pdf › frind3 › frind3-vol1andvol2.

Hobbs B, Bush A, Shaikh B, Azmat S, Mazhar A, Solter S, et al. Acute malnutrition: an everyday emergency. A 10-point plan for tackling acute malnutrition in under-fives. JPMA J Pak Med Assoc. 2013;63:S6(9)-72.

Mwangome MK, Fegan G, Prentice AM, Berkley JA. Are diagnostic criteria for acute malnutrition affected by hydration status in hospitalized children? A repeated measures study. Nutr J. 2011;10(1):92.

Indian Academy of Pediatrics (IAP). IAP guidelines 2006 for hospital-based management of severely malnourished children (adapted from WHO guidelines). Indian Pediatr. 2007;44:443-61. Available at: PUBMED.

Ashworth A, Ashworth A, Khanum S, Schofield C. Guidelines for the inpatient treatment of severely malnourished children. World Health Organization; 2003;99:S57(55)-42.

Taneja G, Dixit S, Khatri AK, Yesikar V, Raghunath D, Chourasiya S. A study to evaluate the effect of nutritional intervention measures on admitted children in selected nutrition rehabilitation centers of Indore and Ujjain divisions of the state of Madhya Pradesh (India). Indian J Comm Medi. 2012 Apr;37(2):107.

Ratnayake R, Tesfai C, Myatt M. Determining predictors for severe acute malnutrition: causal analysis within a SQUEAC assessment in Chad. Field Exchange. 2013;45:23-5.

Mamidi RS, Kulkarni B, Radhakrishna KV, Shatrugna V. Hospital based nutrition rehabilitation of severely undernourished children using energy dense local foods. Indian Pediatr. 2010 Aug 1;47(8):687-93.

Aprameya HS, Kamath SP, Kini PK, Baliga BS, Shenoy UV, Jain A, Rao BN. Socioepidemiological determinants of severe acute malnutrition and effectiveness of nutritional rehabilitation center in its management. Inte J Health Allied Scie. 2015 Jul 1;4(3):148.

Ministry of Health and Family Welfare, Government of India. Operational guidelines on facility-based management of children with severe acute malnutrition. New Delhi, India: National Rural Health Mission, Ministry of Health and Family Welfare; 2011. Available at: › MTC Guideline- MOHFW.






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