All children who satisfy the criteria for Severe Acute Malnutrition (SAM) will be enrolled in this project after counseling and consent of their parents. Children with SAM having complication will be admitted at LTMGH, Sion. They will be stabilized with F75 and F100 alongwith emergency care and then enrolled in the project. Uncomplicated SAM children will be enrolled at NRRTC on OPD bases. This include immune-compromised (irrespective of ART) as well as children infected with tuberculosis (TB) after ruling out significant underlying disease. They will be treated atleast for period of 14days (maximum 3months) alongwith the mother or caretaker of the child. All the details would be entered in the predesigned and pretested proforma.

1.      Nutritional History: Detailed nutritional assessments will be done at baseline, 2 weekly thereafter for 6 weeks and then monthly for 6 months from the baseline. At each evaluation the history of the child’s eating habits, food allergies and use of nutritional supplements, history of nausea, vomiting, abdominal pain, abdominal distention, and diarrhea or constipation would be assessed.

2.      2. Anthropometric measurements: Weight, height/ length and Mid upper arm circumference (MUAC) would be done at baseline, 2 weekly thereafter for 6 weeks and then monthly for 6 months from the baseline. Weight would be measured to the nearest 100g on a regularly calibrated electronic scale with the child standing barefoot/sleeping and undressed. Height would be measured to the nearest 1 mm using standard measuring techniques; the mean of two readings would be calculated for each child. For measurement of MUAC, with the forearm held perpendicular to the upper arm, a paper measuring tape would be used to record the circumference at the mid-point between the olecranon process of the ulna and the acromial process of the scapula. The mean of 3 measurements was used for analysis.