e-Library of Evidence for Nutrition Actions (eLENA)


An online library of evidence-informed guidelines for nutrition interventions and single point of reference for the latest nutrition guidelines, recommendations and related information.

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Identification of severe acute malnutrition in children 6–59 months of age

Intervention | Last updated: 15 May 2023

In children who are 6–59 months of age, severe acute malnutrition is defined by a very low weight-for-height/weight-for-length, or clinical signs of bilateral pitting oedema, or a very low mid-upper arm circumference. Severe acute malnutrition affects an estimated 19 million children under 5 years of age worldwide and is estimated to account for approximately 400,000 child deaths each year.

Early identification of severe acute malnutrition is important for initiating treatment and minimizing the risk of complications. This can be done in both community and health-care settings using appropriate indicators.

WHO Recommendations

In community settings, trained community health workers and community members should measure the mid-upper arm circumference of infants and children who are 6–59 months of age, while in primary health-care facilities and hospitals, health-care workers should assess the mid-upper arm circumference or the weight-for-height/weight-for-length status. In both settings infants and children should be examined for bilateral pitting oedema.

Infants and children who are 6–59 months of age and have a mid-upper arm circumference <115 mm, or a weight-for-height/length <–3 Z-scores of the WHO Child Growth Standards median, or have bilateral pitting oedema, should be referred for full assessment at a treatment centre for the management of severe acute malnutrition.

Children who have appetite (pass the appetite test) and are clinically well and alert should be treated as outpatients.



Guidelines and guidance documents Learn More Alternate Text

GRC-approved guidelines

Guideline: updates on the management of severe acute malnutrition in infants and children

Pocket book of hospital care for children: Second edition

Other guidance documents

Caring for newborns and children in the community: package of resources

WHO child growth standards and the identification of severe acute malnutrition in infants and children

Joint statement on the community-based management of severe acute malnutrition

Management of severe malnutrition: a manual for physicians and other senior health workers

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Cost-effectiveness analyses

The analyses listed below were conducted to assess the overall cost-effectiveness of inpatient and/or outpatient management of SAM, of which the intervention listed on this webpage is a component. The analyses do not assess the cost-effectiveness of this specific intervention alone.

Cost-effectiveness of community-based management of acute malnutrition in Malawi

Wilford R, Golden K, Walker DG. Health Policy Plan. 2012; 27(2):127-37.

Cost-effectiveness of the community-based management of severe acute malnutrition by community health workers in southern Bangladesh

Puett C, Sadler K, Alderman H, Coates J, Fiedler JL, Myatt M. Health Policy Plan. 2013; 28(4):386-99.

Cost effectiveness of community-based therapeutic care for children with severe acute malnutrition in Zambia: decision tree model

Bachmann MO. Cost Eff Resour Alloc. 2009 Jan; 7:2.

Cost effectiveness of a community based prevention and treatment of acute malnutrition programme in Mumbai slums, India

Goudet S, Jayaraman A, Chanani S, Osrin D, Devleesschauwer B, Bogin B, et al. PLoS One. 2018; 13(11):e0205688.

Economic Cost of Community-Based Management of Severe Acute Malnutrition in a Rural District in Ghana

Abdul-Latif A-M C, Nonvignon J. Health. 2014; 6: 886-899.

The cost-effectiveness of forty health interventions in Guinea

Jha P, Bangoura O, Ranson K. Health Policy Plan. 1998; 13(3):249-62.

Cost effectiveness of community-based and in-patient therapeutic feeding programs to treat severe acute malnutrition in Ethiopia

Tekeste A, Wondafrash M, Azene G, Deribe K. Cost Eff Resour Alloc. 2012; 10:4.

Costs, cost-effectiveness and financial sustainability of community-based management of acute malnutrition in northern Nigeria

Frankel S, Roland M, Makinen M. Washington DC: Results for Development Institute; 2015.

Category 1 intervention

Guidelines have been recently approved by the WHO Guidelines Review Committee

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Essential Nutrition Actions

This intervention is a component of managing children with SAM, which is an Essential Nutrition Action targeting the first 1000 days of life.

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