We read the two recent publications [1,2] related to Severe acute malnutrition (SAM), and wish to highlight certain issues. The prevalence of bilateral pitting edema was found to be 8.1% [1] and 27% [2]. These proportions are very high. Recent National Nutrition Monitoring Survey Report [3] has reported the time trends in prevalence of Kwashiorkor as 1.2% (1975-79), 0.2% (1988-1990), 0.8% (1996-1997) and 0% (2011-2012) [3]. The reasons for high prevalence of bilateral pitting edema found in Uttar Pradesh and Madhya Pradesh need to be elaborated.

The study that was conducted in twelve Nutrition Rehabilitation Centers (NRCs) in Uttar Pradesh [1] documented high defaulter rates (49% and 46%) amongst SAM children with complications admitted to NRCs and uncomplicated SAM children, respectively. With such a high defaulter rate, the results documenting mortality of 1.2% amongst SAM children admitted to NRCs are not valid. What were the reasons for high defaulter rate amongst complicated and uncomplicated SAM children? This information could help immensely in improving the functioning of NRCs in other states for efficient management of children with SAM.

1. Singh K, Badgaiyan N, Ranjan A, Dixit HO, Kaushik A, Kushwaha KP, et al. Management of children with severe acute malnutrition: Experience of nutrition rehabilitation centres in Uttar Pradesh, India. Indian Pediatr. 2014; 51:21-5.

2. Kumar R, Singh J Joshi K, Singh HP, Bijesh S. Co-morbidities in hospitalized children with severe acute malnutrition. Indian Pediatr. 2014;51:125-7.