The 8.1% prevalence of bilateral pitting edema among children with SAM admitted in the 12 NRCs in Uttar Pradesh should not be confused with the prevalence of Kwashiorkor as found in the nutrition surveys in the community. The proportion of patients admitted in a health facility with a certain health condition may not correlate with its prevalence in the community. It would also be important to note that the frontline workers during their training on identification and referral of children with SAM are specifically trained on the need to identify and refer children with bilateral pitting edema to the NRCs as these children are at a much high risk of death. These frontline workers make special effort in convincing the family of children with bilateral pitting edema for admission and treatment in NRCs.

The paper mentions that of the total program exits, 1.2% children died. The focus of this paper was on the outcomes of children with SAM while in the program. The outcome of children who defaulted is beyond the scope of the paper. The paper also acknowledges and highlights the high default rates and has recommended further investigation for corrective action.