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Case fatality rate for SAM and MAM with reference

This question was posted the Management of wasting/acute malnutrition forum area and has 3 replies.

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Anonymous 2243

Normal user

29 Aug 2018, 18:07

Dear colleagues,
Appreciate if anyone can share reference with case fatality rate for Severe and Moderate Acute Malnutrition.


Mark Myatt

Frequent user

30 Aug 2018, 08:51

Here are some references that you may find useful:

Alam N, Wojtyniak B, Rahaman MM, Anthropometric indicators and risk of death, Am J Clin Nutr, 1989;49:884-888

Bairagi R, Chowdhury MK, Kim YJ, Curlin GT, Alternative anthropometric indicators of mortality, Am J Clin Nutr, 1985;42:296-306

Briend A, Zimicki S, Validation of arm circumference as an indicator of risk of death in one to four year old children, Nutr Res, 1986;6:249-261

Briend A, Wojtyniak B, Rowland MGM, Arm circumference and other factors in children at height risk of death in rural Bangladesh, Lancet, 1987;26:725-727

Briend A, Garenne M, Maire B, Fontaine O, Dieng K, Nutritional status, age and survival: The muscle mass hypothesis, Eur J Clin Nutr, 1989;43(10):715-26

Briend A, Dykewixz C, Graven K, Mazunder RN, Wojtyniak B, Bennish M, Usefulness of nutritional indices and classifications in predicting the death of malnourished children, Br Med J, 1986;293:373-275

Chen LC, Chowdhury MK, Huffman SL, Anthropometric assessment of energy-protein malnutrition and subsequent risk of mortality among pre-school children, Am J Clin Nutr, 33; 1980;33:1836-1845

Heywood PF, Nutritional status as a risk factor for mortality in children in the highlands of Papua New Guinea, Proceedings of the Thirteenth International Congress of Nutrition, Brighton, 1986:103-106

Katz J, West KP, Tarwotjo I, Sommer A, The importance of age in evaluating anthropometric indices for predicting mortality, Am J Epidemiol, 1989;130(6):1219-1226

Kielman AA, McCord C, Weight-for-age as an index of risk of death in children, Lancet, 1978;10:1247- 1250

Pelletier DL, The relationship between child anthropometry and mortality in developing countries: Implications for policy, programs, and future research, J Nutr, 1994;124:2047S-2081S

Pelletier DL, Frongillo EA, Habicht JP, Epidemiologic evidence for a potentiating effect of malnutrition on child mortality, American Journal of Public Health, 1983;83:1130-1133

Smedman L, Sterky G, Mellander L, Wall S, Anthropometry and subsequent mortality in groups of children aged 6-59 months in Guinea-Bissau, Am J Clin Nutr, 1987;46:396-73

Sommer A, Nutritional anthropometry and mortality risk, Am J Clin Nutr, 1981;34:2591-2560

Sommer A, Lowenstein MS, Nutritional status and mortality: A prospective validation of the QUAC stick, Am J Clin Nutr, 1975;28:287-292

Vella V, Tomkins A, Ndiku J, Marshal T, Cortinovis I, Anthropometry as a predictor for mortality among Ugandan children allowing for socio-economic status, Eur J Clin Nutr, 1994;48:189–197

This material is reviewed in:

Myatt M, Khara T, Collins, S, A review of methods to detect cases of severely malnourished children in the community for their admission into community-based therapeutic care programs. Food and Nutrition Bulletin, 2006, 27(3 Suppl), S7–23

That review is available here.

I hope this is useful.

Jay Berkley


Frequent user

5 Sep 2018, 10:46

Please be aware that there are major differences in populations that need to be considered in interpretation of mortality data:

- community cohorts of untreated children
- treated uncomplicated SAM/MAM
- treated complicated SAM/MAM
- older studies where complicated and uncomplicated SAM were not distinguished


Mark Myatt

Frequent user

5 Sep 2018, 11:12

Jay is correct.

The references above are for "community cohorts of untreated children" and the complicated and uncomplicated SAM were often not distinguished. This sort of data is useful for deciding on indicators and thresholds for admission into programs.

The other three classes that Jay lists are all about program effectiveness. This depends on quite a large of factors (i.e not just doctors, nursed, RUTF and drugs but coverage, recruitment, retention, costs to the beneficiary, and so-on). Mortality is expressed in SPHERE minimum standards. The expectation is that mortality in therapeutic feeding programs should be below 10%. This is a minimum standard and is usually achieved after a few months of program operation.

I hope this is of some use.

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