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Introduction: Malnutrition is a major public health problem, especially in Low- and Middle-Income Countries (LMICs), contributing significantly to under-five mortality. New strategies are needed to enhance outcomes for childhood malnutrition. Aim: To evaluate the impact of an educational package on mothers of children hospitalised with Severe Acute Malnutrition (SAM). Materials and Methods: This was a hospital-based randomised controlled trial conducted in the Department of Paediatrics at Gajra Raja Medical College, Gwalior, Madhya Pradesh, India. Only children hospitalised between 6 months and 59 months of age with SAM were included and randomised into an Intervention group and a Control group. In the intervention group, verbal, pictorial, and demonstration techniques were used to educate the mothers. Anthropometric measurements of malnourished children and maternal knowledge scores were compared at baseline, 15 days, and two months postdischarge. Frequency and percentage were calculated for qualitative data analysis, while mean values with standard deviations were calculated for quantitative data. Independent t-tests and paired t-tests were applied, and paired t-tests were used for within-group comparisons at different time points. Data was entered into Microsoft Excel software, and analysis was performed using Statistical Package for Social Sciences (SPSS) version 22.0. Results: The mean age of children was 1.4±0.9 years, with the majority below two years of age (86.4%). The male-to-female ratio was 1.04 (n=154 versus n=148). Most subjects belonged to lower or upper-lower socio-economic classes (75%). Mothers were commonly educated up to the primary school level (48%). Both study groups had similar socio-demographic profiles. There was a significant weight gain (p-value <0.01) and height gain (p-value <0.01) in the intervention group at the end of the follow-up period. Maternal knowledge gain in the intervention group was also significantly higher than in the control group (p-value <0.01). Conclusion: This study supports maternal educational strategies as a low-cost intervention to address early childhood malnutrition in resource-limited settings. Further research is needed to standardise the intervention and assess long-term impact. [ABSTRACT FROM AUTHOR]

Introduction: Orthorexia nervosa (ON) is characterized by a relentless, uncomfortable intrusive thought pattern, stereotyped behavior, and an extreme worry about maintaining a healthy diet that pulls all consideration to food. This compulsive behavior may affect daily functioning. Medical complications of orthorexic behavior include malnutrition, anemia, digestion problems, electrolyte, hormonal imbalance, severe weight loss and excessive anxiety. Like other eating disorders, this condition causes many psychological and medical complications, and research in this area is limited. Therefore, the reason for conducting this research was to determine the prevalence and severity of ON in medical students. Aims and Objectives: To determine the prevalence of ON in the 263 research samples, to compare prevalence among undergraduates and postgraduates, and to determine the association between demographic variables and a 15 item questionnare for diagnosis of orthorexia nervosa ORTO-15 scores. Materials and Methods: A cross-sectional study was carried out to determine the prevalence of ON on the ORTO-15 scale among medical students. Sociodemographic details such as age, gender, body mass index, and level of physical activity were obtained from the study sample. Results: ON was prevalent in 29.86% of the study population (ORTO-15 score ≥40). Females had more tendency than males. ON was more prevalent in postgraduates and undergraduates, with a prevalence of 26.7% and 26.98%, respectively. Eating habits and ORTO-15 scores had a significant association. Conclusion: The propensity for ON is widespread among medical students. Increased knowledge of nutritious eating will aid in problem prevention. [ABSTRACT FROM AUTHOR]

Background Globally 36% of deaths and 42% of Disability Adjusted Life Years (DALYs) are due to communicable, maternal, perinatal and nutritional disorders (CMPND). We examined the state-wise disease burden and treatment cost for these diseases in India for 2017. Methods DALYs for CMPND was obtained from National Disease Burden Estimate (NBE) Study and the expenditure was determined from the unit level records of persons who reported hospitalization for one or more CMPND in National Sample Survey (NSS)—75th Round. Results The top conditions resulting in high DALYs for India were perinatal conditions and nutritional deficiency disorders. Odisha had the highest DALY rate, while Kerala had the lowest DALY rate for CMPNDs. The out-of-pocket expenditure (OOPE) was highest in Chattisgarh, while percentage of households pushed to CHE was highest in Uttar Pradesh for CMPND. Conclusion The public healthcare facilities need to be strengthened to facilitate patients with CMPND to undergo treatment that is timely, affordable and cost-effective. Efforts should be made for optimization of strategies aimed at primary and secondary prevention of CMPND and reduce OOPE for treatment of these diseases. In addition, advocacy spreading awareness will reduce the burden and treatment expenditure for CMPNDs in India. [ABSTRACT FROM AUTHOR]

Background: In India, Nutrition Rehabilitation Centers (NRCs) established at public health facilities provide residential medical nutrition therapy for severe acute malnutrition (SAM) children with complications. A large proportion of their mothers are also malnourished. NRCs do not provide services to such mothers as part of routine practice. However, technical algorithm for delivering Maternal Nutrition (MN) services in facility settings is available. Objectives: To test the practical feasibility of layering the MN services in NRC as a routine service. Methods: The MN services were delivered by a nutrition counselor using a triage approach (assess, classify, supplement/counsel/treat). All mothers received diet, micronutrients, and group counseling, those at nutritional risk received individual counseling and SAM mothers also received catch-up diet during their stay. Program data were collected from mothers during January 1 to August 31, 2019 at the NRC in Kalawati Saran Children Hospital. To gain operational insights, a structured interview with nutrition counselor was conducted. Results: Out of 168 mothers, 8% were found to be pregnant and 89% were at nutrition or medical risk. The prevalence of short stature was 18%, severe/ thin 21%, overweight/obese 34%, and anemic 72%. Feedback from the nutrition counselor indicated no operational challenges, however, further efforts to ensure that mothers keep coming back for follow-up visits is needed. Conclusion: The findings indicated that existing staffs were able to deliver the MN services within the time, cost, and regime of the routine NRC. This paper provides four recommendations for layering the MN services in NRCs. [ABSTRACT FROM AUTHOR]

Background: With global survival increasing for children younger than 5 years of age, attention is required to reduce the approximately 1 million deaths of children aged 5-14 years occurring every year. Causes of death at these ages remain poorly documented. We aimed to explore trends in mortality by causes of death in India, China, Brazil, and Mexico, which are home to about 40% of the world's children aged 5-14 years and experience more than 200 000 deaths annually at these ages.Methods: We examined data on 244 401 deaths in children aged 5-14 years from four nationally representative data sources that obtained direct distributions of causes of death: the Indian Million Death Study, the Chinese Disease Surveillance Points, mortality data from the Mexican Instituto Nacional de Estadística y Geografía, and mortality data from the Brazilian Institute of Geography and Statistics. We present data on 12 main disease groups in all countries, with breakdown by communicable and nutritional diseases, non-communicable diseases, injuries, and ill-defined causes. To calculate age-specific and sex-specific death rates for each cause, we applied the national cause of death distribution to the UN mortality envelopes for 2005-16 for each country.Findings: Unlike Brazil, China, and Mexico, communicable diseases still account for nearly half of deaths in India in children aged 5-14 years (73 920 [46·1%] of 160 330 estimated deaths in 2016). In 2016, India had the highest death rates in nearly every category, including from communicable diseases. Fast declines among girls in communicable disease mortality narrowed the gap by 2016 with boys in India (32·6 deaths per 100 000 girls vs 26·2 per 100 000 boys) and China (1·7 vs 1·5). In China, injuries accounted for the greatest proportions of deaths (20 970 [53·2%] of 39 430 estimated deaths, in which drowning was a leading cause). The homicide death rate at ages 10-14 years was higher for boys than for girls in Brazil, increasing annually by an average of 0·7% (0·3-1·1). In India and China, the suicide death rates were higher for girls than for boys at ages 10-14 years. By contrast, in Mexico it was higher for boys than for girls, increasing annually by an average of 2·8% (2·0-3·6). Deaths from transport injuries, drowning, and cancer are common in all four countries, with transport accidents among the top three causes of death for both sexes in all countries, except for Indian girls, and cancer in the top three causes for both sexes in Mexico, Brazil, and China.Interpretation: Most of the deaths that occurred between 2005 and 2016 in children aged 5-14 years in India, China, Brazil, and Mexico arose from preventable or treatable conditions. This age group is important for extending some of the global disease-specific targets developed for children younger than 5 years of age. Interventions to control non-communicable diseases and injuries and to strengthen cause of death reporting systems are also required.Funding: WHO and the University of Toronto Connaught Global Challenge. [ABSTRACT FROM AUTHOR]

Background: Severe acute malnutrition (SAM) is a salient health problem in India. Federation of Indian Chamber of Commerce and Industry (FICCI) Research and Analysis Centre, New Delhi, prepared nutreal equivalent to ready-to-use therapeutic food by World Health Organization (WHO) for the management of SAM and defined food like homemade diet.Objective: To compare acceptability and efficacy of nutreal over defined food for the management of SAM.Methods: One hundred twelve children aged less than 5 years with SAM were enrolled as per the standard of WHO. Children were randomized into 2 groups to receive nutreal (n = 56) and defined food (n = 56) in unlimited amounts for 42 consecutive days and extended by 2 weeks as per demand. Calorie and protein intake, weight, and mid-upper arm circumference (MUAC) were recorded daily.Results: Age range was 8 to 45 months. Ninety-three percent of children eagerly accepted nutreal but 7% does not. Whereas in the defined food group, 68% accepted eagerly, 30% did not accept eagerly, and 1.8% accepted poorly ( P = .004). At enrollment, mean weight in the nutreal group was 6.44 ± 1.60 kg and in the defined food group was 8.69 ± 1.76 kg, with MUAC in the nutreal group being 11.12 ± 0.47 cm and in the defined food group being 11.54 ± 0.34 cm. Mean weight in the nutreal and defined food groups at eighth week of intervention was 7.97 ± 1.8 kg and 9.71 ± 1.8 kg ( P < .001), respectively. Mid-upper arm circumference at eighth week was 12.10 ± 0.29 cm in the nutreal group and 12.49 ± 0.50 cm in the defined group ( P < .001).Conclusion: Acceptability, mean weight gain, and MUAC in the nutreal group are greater than the defined food. [ABSTRACT FROM AUTHOR]

This paper brings together recent evidence on what has come to be referred to as the triple burden of malnutrition-consisting of overnutrition, undernutriton, and micronutrient deficiencies-using various anthropometric, biochemical, and diet quality indicators, and juxtaposing these against changes in relative prices. The evidence points to the rapid emergence of overweight as a public health problem, widespread not only in urban, but also in rural areas; associated noncommunicable diseases are also on the rise. Over time, while most indicators of undernutrition have improved, magnitudes are nonetheless high; a persistent problem is anemia, the prevalence of which remains high and unchanged. As for food, more than quantity, it is its quality that appears to be correlated with malnutrition. Yet improvements in diet quality have not been high, and micronutrient intakes remain low. It has become increasingly difficult for the poor to have a diet rich in vegetables, dairy and meat, as their prices (per unit calorie), relative to cereals, have risen faster than for the rich. [ABSTRACT FROM AUTHOR]

Background: In developing countries, dental caries is the most common disease of the early childhood. Its increased prevalence in younger age group have been predictive of oral health problems in future, affecting oral health and development leading to several morbid conditions of oral and general health. Prevalence and incidence of dental caries is highly influenced by a number of risk factors such as gender, age, socioeconomic status, dietary patterns, and oral hygiene habits.Aim: To assess social, demographic determinants and oral hygiene practices in relation to dental caries among the children attending Anganwadis of Hingna, Nagpur.Materials and Methodology: A cross sectional study in 27 Anganwadis of Hingna, Nagpur was carried out over a period of two months and a total of 324 subjects attending the Anganwadis were enrolled. Social, demographic and oral hygiene practices in relation to dental caries were assessed in the study population.Results: Out of 324 subjects, 206 had dental caries and 38 were found to be malnourished. A significant association was found among age, malnutrition, parent's educational status, oral hygiene practices, total number of siblings, and dental caries.Conclusion: Anganwadis should be addressed routinely on effective oral and general health promoting strategies which must include education of parents, oral and general health issues, risk factors for dental caries, and malnutrition in children below 5 years of age. [ABSTRACT FROM AUTHOR]

A recent global hunger index indicated a 12 percent decline in child underweight rates. This study attempts an empirical explanation of the factors that influence child underweight rates at the district level. Agricultural land productivity, share of women educated above the secondary level and participating in work, maternal, and child health seem to contribute to the reduction in child underweight. However government health and water supply facilities turn out to be ineffective. [ABSTRACT FROM AUTHOR]

The consequences of early childbearing on the growth and nutritional status of women in India has not been quantified in previous studies. Our study aimed to fill this gap by analysing the association between early marriage and early childbearing on nutritional status of Indian women, with a focus on Bihar and Andhra Pradesh, the two states accounting for the highest proportion of women marrying and giving first birth before 18 years of age. Our findings revealed that a substantial number of women were married before 18 years and thereby exposed to early pregnancy. Furthermore, a significantly higher proportion of women in the 'thin' category were married before 18 years, both in the Indian sample (33 %, p < 0.001) and in the selected states, Andhra Pradesh (31 %, p < 0.001) and Bihar (43 %, p < 0.001), compared to those women married at higher ages. Similarly, across all our samples women whose first birth was before age 18 years also had a significantly higher probability of being in the 'thin' category across all our samples. This pattern was also observed for associations between early childbirth and anemia levels. We conclude that the net effect of the early age at marriage and age at first birth on nutritional status is significant. Our results underline the need for preventing early marriages and the consequent high adolescent pregnancies in India, particularly in high prevalence states. This will help to improve nutritional status and health care utilisation among women, thereby, prevent maternal and child mortality and thus, achieve the MDGs 4-5. [ABSTRACT FROM AUTHOR]

Malnutrition among under-five children is an important concern for the health authorities in India. The aim of the present review was to assess the burden of under-nutrition and over-nutrition, its determinants and strategies required to tackle malnutrition among under-five children in India. Recent data were collected from Google search, Medline, and others. The information retrieved was reviewed and analyzed for discrepancies. Existing evidence shows that the prevalence of under-nutrition among under-five children was high and varied widely (under-weight: 39-75%, stunting: 15.4-74%, wasting: 10.6-42.3%) depending on the assessment methodology adopted. Studies on assessment of over-nutrition status among under-five children were limited. Distribution of various types of risk factors and its influence on nutrition status of children in a given set up should be analyzed for planning the control measures. Strengthening public health interventions for mild malnutrition cases and vulnerable groups, effective implementation and evaluation of the strategies at regional level, research on overweight, obesity and its etiological factors and steps for improving socioeconomic development are the prerequisites for tackling malnutrition among under-five children in India. [ABSTRACT FROM AUTHOR]

The present prospective observational study was carried out in a tertiary care hospital in New Delhi, India from May 2014 to June 2015 to report adverse drug reactions (ADRs) in patients with type 2 diabetes mellitus (T2DM) using antidiabetic drugs. A total of 220 patients (121 males, 99 females) were enrolled. ADRs were recorded on the prescribed form. Causality and severity assessment was done using Naranjo's probability scale and modified Hartwig and Siegel's severity scale, respectively. Commonly prescribed drugs were biguanides, peptide hormone and sulphonylurea. A total of 26 ADRs were recorded (16 in males and 10 in females). Most commonly observed ADRs were related to endocrine and gastrointestinal system. Severity assessment of ADRs showed seven (26.9%) ADRs as moderate, and 19 (73.1%) as mild. No severe reactions were observed. ADRs were mostly related to endocrine and gastrointestinal system. More information on prescribed drugs and their side effects is required for ensuring patient safety. [ABSTRACT FROM AUTHOR]

The young people in the age group of 10-24 yr in India constitutes one of the precious resources of India characterized by growth and development and is a phase of vulnerability often influenced by several intrinsic and extrinsic factors that affect their health and safety. Nearly 10-30 per cent of young people suffer from health impacting behaviours and conditions that need urgent attention of policy makers and public health professionals. Nutritional disorders (both malnutrition and over-nutrition), tobacco use, harmful alcohol use, other substance use, high risk sexual behaviours, stress, common mental disorders, and injuries (road traffic injuries, suicides, violence of different types) specifically affect this population and have long lasting impact. Multiple behaviours and conditions often coexist in the same individual adding a cumulative risk for their poor health. Many of these being precursors and determinants of non communicable diseases (NCDs) including mental and neurological disorders and injuries place a heavy burden on Indian society in terms of mortality, morbidity, disability and socio-economic losses. Many health policies and programmes have focused on prioritized individual health problems and integrated (both vertical and horizontal) coordinated approaches are found lacking. Healthy life-style and health promotion policies and programmes that are central for health of youth, driven by robust population-based studies are required in India which will also address the growing tide of NCDs and injuries. [ABSTRACT FROM AUTHOR]

Background: Hypertension becoming common health problem worldwide because of increasing longevity and prevalence of contributing factors such as obesity, physical inactivity and an unhealthy diet. Objective: To study the prevalence of risk factors for hypertension among women in rural area of South India Material and method: A community based cross-sectional study was conducted among 837 women selected from rural area of Andhra Pradesh from January to June 2008 Results: Out of 837 women, 22.58% were hypertensive. The age specific prevalence of hypertension was maximum(50.44%) in the age group > 60 yrs. Risk factors such as family h/o HTN,h/o DM,tobacco use, waist circumference and BMI were significantly associated with hypertension. Conclusion: Problem of hypertension is increasing among rural women so health education strategies should be directed towards rural women also. [ABSTRACT FROM AUTHOR]

Background: Weaning plays a major role in determining the nutritional status of a child. Poor weaning practices during infancy and early childhood, resulting in malnutrition, contribute to impairment of cognitive and social development, poor school performance and reduced productivity in later life. The objective of this study is to know weaning practices of mothers of difficult terrain. Methods: Cross-sectional study was conducted in all villages under Rural Health Training Center, the field practice area of Department of Community Medicine. A total of 500 mothers with children within 3 years of age were included in the study. Pre-tested pre-designed semi-structured questionnaire was used to collect information on weaning practices. Results: Majority of children (51.57%) were weaned at >6 months and were observed to be more under nourished (79.34%) as compared with those between 4 months and 6 months (61.50%). Majority of boys were weaned earlier than girls irrespective of the age of the weaning. Malnutrition was found in majority of those children who were weaned inadequately in terms of both frequency and amount. Conclusions: The present study revealed suboptimal weaning practices among the mothers of hilly region. Thus, appropriate educational strategies should be directed particularly on counteracting various myths related to infant feeding Moreover, promotion of appropriate feeding should target not only on maternal caregivers, but also on other family members, particularly husbands and grandmothers, taking into account the social and cultural situation of the area. [ABSTRACT FROM AUTHOR]

Background: India shares the largest burden of under-nutrition in world. The aim of this study was to conduct follow-up assessment of under-nourished children attending anganwadi center (AWC). Methods: This was a retrospective cohort study conducted in 50 AWC of Tapi district. Total 529 children aged 1-6 years diagnosed as under-nourished before 1 year were included. Pre-structured questionnaire was used for present day assessment of these children followed by Epi-info mediated analysis. Results: Children of literate mothers had higher weight gain. Ninety percent of children attended anganwadi regularly, however 25% of children dropped out for more than 1 month. In 1 year, growth had faltered in 20% children and was stagnant in 63% of them. Children who were treated for under-nutrition; that completed course at Child Development and Nutrition Center; and whose parents were counseled about the under-nourished status of child had higher weight gain than their counterparts. Conclusions: Parents of under-nourished children must be counseled about the nutritional status of their child. In cases of under-nourished child, referral to higher center must be ensured by health worker. Supplementary feeding as a long-term solution to country's under-nutrition problem should be studied in detail with the alternative solutions. [ABSTRACT FROM AUTHOR]

This study was conducted to profile nutritional risk factors in a population of community-dwelling older adults in Kolkata, India. We applied the short version of the Mini Nutritional Assessment–Short Form (MNA-SF) questionnaire among 500 participants (65 to 75 years)—263 males and 237 females. The prevalence of undernutrition was 8.8% in females and 4.9% in males; a risk of undernutrition was found in 24.5% females and 17.5% males. All those with undernutrition or at-risk were studied further using the full version of the MNA. Data regarding education, occupation, socioeconomic status, and food intake pattern were also collected. Females had a significantly lower (P < 0.01) education level than males; 73.4% males were financially independent, whereas 72.7% females were financially dependent on others. Moderate appetite loss was commonly found (64.9%), and in 24.3% of the participants appetite loss was severe. Digestive and chewing problems were present in 32.4% and 21.6% of study participants, respectively. The rate of psychological stress and/or acute disease 3 months prior to study was 47%, and 62.2% of the study population were taking 3 or more medicines per day. Weight loss of greater than 3 kg and of 1 to 3 kg during past 3 months of the study period was observed in 27% and 32.5% of the population, respectively. Undernourished individuals were also found to consume fewer protein-rich foods. We hypothesize that low education levels and lack of financial independence were the strongest underlying causes of high undernutrition in this population, particularly, among females. [ABSTRACT FROM AUTHOR]

Background/objectives: Northeastern Indian region has a high density of marginalised populations with a concerning quality of health services. We observed the trends in prevalence of infectious diseases and nutritional disorders among children under-five years from 2006 to 2020 in the Northeastern states. We also assessed the distribution of their burden by place of residence., Methods: A secondary data analysis of select indicators on infectious diseases and nutritional disorders in seven Northeastern states across three rounds of the National Family Health Survey (2005-06, 2015-16, 2019-20) was undertaken. We calculated outcome indicator mean prevalence, relative change and average annual rates of reduction of the indicators., Results: A significant relative reduction between 2006-2020 in the prevalence of diarrhoea (0.4 [95CI:0.7,0.1]) at p &lt; 0.05; acute respiratory illness (ARI) (0.7 [95CI:0.1,0.4]), stunting (0.3 [95CI: 0.3,0.12]) and underweight (0.3 [95CI:0.5,0.2]) at p &lt; 0.001 were noted. However, overweight prevalence increased (10.1[95CI:4.3,16.0, p &lt; 0.001]) due to a low annual reduction rate. The highest annual reduction rates were observed in Sikkim and Tripura for diarrhoea and ARI respectively (&gt;10.0%), and in Meghalaya for wasting and severely wasting (6.3%). Rural areas had a higher burden of stunting, wasting (including severe), underweight, anaemia and diarrhoea; overweight was seen in both rural and urban settings., Conclusion: Significant reductions were observed in ARI, diarrhoea, stunting and underweight prevalence between 2006-2020, with sub-regional variations and a greater burden in rural areas. During this period, overweight prevalence worsened; and anaemia showed a large increase from 2016. To reduce the equity-gap, programmes should be adapted to meet the differential needs of the Northeastern states., (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Overweight and obesity are epidemic and a 'public health crisis' among adolescents worldwide,The rising trends in adolescent obesity in girl are poorly documented in India,The aim of this study was to compare and assess the extent of overweight and obesity in early adolescent school girls using three references [World Health Organization (WHO) 2007; the Center for Diseases Control (CDC) 2000 and the International Obesity Task Force (IOTF) 2000], Methods: A cross sectional study was designed in 1375 early adolescent girl (10-14 years), in five Government affiliated schools of Kharagpur Municipality of West Bengal, India, Results: Results of this study are eloquent of the fact that the roots of obesity lies in early stage of adolescence,Incidence of overweight, including obesity of participants was 10.62%, 7.64% and 7.49% depending on the references used (WHO, CDC and IOTF) respectively,Both incidence and remission rates were higher among younger girls, Conclusions: Regarding the harmful ramifications of overweight and obesity, it is encourage to healthy eating patterns and increase physical activity among early adolescent girls. [ABSTRACT FROM AUTHOR]

Justification: Severe acute malnutrition (SAM) is a major public health issue. It afflicts an estimated 8.1 million under-five children in India causing nearly 0.6 million deaths. The improved understanding of pathophysiology of SAM as well as new internationally accepted growth charts and newer modalities of integrated intervention have necessitated a relook at IAP recommendations. Process: A National Consultative Meeting on Integrated Management of Severe Acute Malnutrition was held in Mumbai on 16th and 17th October, 2010. It was attended by the invited experts in the field. Extensive discussions were held as per the program. The participants were then divided into six groups for detailed discussions. The groups deliberated on various issues pertaining to the task assigned and presented recommendations of the groups in a plenary session. The participants made a list of recommendations after extensive discussions. A Writing Committee was formed and was entrusted with the task of drawing a Consensus Statement on the basis of these Recommendations. After multiple deliberations, the following Consensus Statement was adopted. Objectives: To critically evaluate the current global evidence to formulate a consensus among stakeholders regarding diagnosis and management of SAM. Recommendations: An integrated management of malnutrition is likely to yield more dividends. Thus, management of SAM should constitute an important component of Integrated Management of Neonatal and Childhood Illnesses (IMNCI) program. Determination of SAM on the basis of Z-scores using WHO Growth charts is considered statistically more appropriate than cut-offs based on percentage weight deficit of the median. Considering the fact that many children with SAM can be successfully managed on outpatient basis and even in the community, it is no more considered necessary to advise admission of all children with SAM to a healthcare facility. Management of SAM should not be a stand-alone program. It should integrate with community management therapeutic programs and linkages with child treatment center, district hospitals and tertiary level centers offering inpatient management for SAM and include judicious use of ready-to-use-therapeutic Food (RUTF). All sections of healthcare providers need to be trained in the integrated management of SAM. [ABSTRACT FROM AUTHOR]