Severe Acute Malnutrition (SAM) Management

Severe Acute Malnutrition (SAM)


Severe acute malnutrition (SAM) is the most extreme and visible form of undernutrition. Rates of malnutrition in Bangladesh are amongst the highest in the world. More than half of the population suffers from malnutrition, among which nearly 450,000 children are affected by SAM.

Children suffering from SAM in Suchana intervention areas are successfully treated using World Health Organization’s guidelines. These guidelines have been shown to be feasible and sustainable even in small district hospitals with limited resources.

To reduce rates of malnutrition in Bangladesh at the local level, Suchana is addressing barriers to food security and nutrition, in collaboration with the Ministry of Health and Family Welfare and local government.

Mina Begum, Success Story

22-year-old Mina Begum lives in Osmaninagar upazila in Sylhet district with her family of five. Two years ago, Mina gave birth to her son, Raidul Islam. “Raidul was born undernourished and underweight,” said Mina. “So, Yesmin apa, a field facilitator, suggested that I participate in the Suchana program and take my son to the community health clinic.

” Suchana’s nutrition-specific interventions address immediate or direct causes of undernutrition by helping to improve maternal and child diet quality and reduce infections. Training and household counselling for beneficiaries address the underlying causes of child nutrition and development include food security, adequate caregiving resources, and access to health services in a safe and hygienic environment.

Heeding the facilitator’s counsel, Mina took Raidul to the community health clinic, where Raidul received treatment for a week. “Raidul’s health is gradually improving. I feed him proper meals three times a day,” said Mina.

A total of 201 community clinics are currently providing nutrition services in Sylhet and Moulvibazar districts. Suchana contributed to the capacity building of community clinic service providers on basic nutrition services like counselling on infant and young child feeding, pregnancy care, maternal nutrition, adolescent nutrition, and micronutrient for women, adolescents, SAM screening, and referral.

Mina received knowledge on infant and young child feeding, maternal and child health and nutrition, and water and sanitation and hygiene. She also participated in nutrition-sensitive interventions such as technical training, linkage building workshops, and mentoring sessions on vegetable production, livestock rearing, and fish farming to increase her family’s nutritional intake.

“Having eggs from my hens and fish from the pond has improved my family’s food intake. Raidul eats eggs and he loves fish. He also drinks in the morning and at night,” said Mina. She also grows vegetables on her homestead farm. The produce helps the family of five to eat healthy food on a daily basis.



“Thanks to Suchana, now I am able to provide nutritious food for my son. His overall health is gradually improving.”

Mina Begum, 22,
Osmaninagar, Sylhet


Improving SAM Management

Suchana organised meetings on how to support MoHFW on SAM management, strengthening national nutrition services, and capacity development of doctors and nurses at the SAM unit.

From 2019-2020, a total of 143 quarterly meetings have been organized with the district and upazila health and family planning department. About 176 meetings with community groups and community support groups have been facilitated by the nutrition team.

Two batches of training on SAM management were organised to develop and improve the capacity of government doctors and nurses of different upazila health complexes and hospitals.


Advantages of combined facilitybased and community-based approach

Suchana has combined a community-based approach with a facility-based SAM management approach in the following ways:

  • Active SAM case identification in the community through rapid screening methods such as midupper arm circumference tape measurement
  • Identification of SAM in children at an early stage will require only 10-15% of children suffering from SAM to be treated under the facility-based in-patient approach
  • Rational use of facility-based in-patient care allows health facilities to focus resources on the specialised care of children with SAM with complications
  • Community-based care for children benefits families by reducing time that caregivers spend away from home, and by reducing costs
  • Maximum coverage and access made possible by making services accessible to highest possible proportion of children suffering from SA


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House CWN (A) 35, Road 43, Gulshan 2, Dhaka 1212