Severe Acute Malnutrition is more than just a socio-economic problem – it is a medical condition that needs urgent attention.

New Delhi/Darbhanga (Bihar), September 1, 2014 – The international medical humanitarian organisation, Doctors Without Borders/Médecins Sans Frontières (MSF) has been working in Bihar’s northern district of Darbhanga since 2009 toward providing curative treatment to severely acute malnourished (SAM) children. SAM is a condition that results from acute decrease in food consumption leading to wasting or loss of body mass and/or oedema. At a time when India has more than 14 lakh children affected by acute malnutrition[1], a pledge to recognize and accept SAM as a medical condition, and to treat it medically at all public health facilities is the need of the hour.


Treatment for SAM patients in Bihar and other states is largely inaccessible, which renders thousands of children undernourished. A June 2014 survey conducted by MSF in collaboration with the District Health Society in Darbhanga recorded the prevalence of SAM at 3.7%[2], which represents nearly 22,000 children under five affected by the condition[3].


So far, MSF has admitted more than 13,000 SAM patients aged 6 months to 5 years in its community-based treatment program in Biraul, a flood-prone block in Darbhanga district. Its data reveal that among the patients admitted, majority of them are less than 2 years old. Also, 87% belong to the poorest and most vulnerable castes and more than 60% are females.


MSF’s experience shows that children with SAM can be successfully detected at the community level with help from community health workers. Accredited Social Health Activists or ASHAs in the villages identify and screen SAM patients, and refer them to the Primary Health Centres (PHCs) where trained government ANMs provide the necessary nutritional and medical care. Only cases with medical complications require inpatient care at a facility that has provision for specialized care and treatment like the Nutritional Rehabilitation Centres (NRCs) or MSF’s Malnutrition Intensive Care Unit (MICU) in Darbhanga.


One must not forget that SAM, if untreated, thwarts growth and cognitive development, which are almost irreversible beyond a point. And while precautionary measures such as economic and food security and proper breastfeeding practices are key interventions in reducing acute malnutrition among children,  recognizing SAM as a medical condition and treating it is just as important.


In close collaboration with the Bihar State Health Society, MSF continues to work with medical staff in the primary health centres in a bid to ensure continuity of care to the needy and sick children. We believe, using the resources within the public health systems not only ensures greater coverage of treatment for SAM children, but also reduces the risk of patients defaulting on treatment.


Bihar is the third most populous state in India carrying the burden of 49.81 % underweight children. We encourage the Indian government to scale up their initiatives to actively treat SAM patients and help eliminate the curse of under nutrition among children.



MSF is an international, independent, medical organization that delivers emergency aid to people affected by armed conflict, epidemics, exclusion from healthcare and natural disasters.

[1]  According to the Status of ICDS Scheme as on 31-12-2013. See page 9 of: :

[2] As per Mid Upper Arm Circumference (MUAC) cutoff (

[3] Population census 2011 estimates Darbhanga’s population to be 3.9 million, of which 15% are children aged between 6 months – 5 years. For more information, see:


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