A holistic approach to malnutrition follow-up care

We thank Dr Kuper for her insightful editorial regarding a more holistic approach to treating undernutrition in developing countries and hope it will further raise the profile of an important issue. The editorial correctly highlights poor post-discharge survival following severe acute malnutrition (SAM) found during a one-year follow-up of patients discharged from inpatient treatment in Malawi in 2006 (1). Subsequent introduction, both internationally and locally (2), of community management of acute malnutrition (CMAM), focuses on earlier and more proactive treatment of SAM and could plausibly improve post-discharge outcomes (3). However, even in CMAM programmes, many vulnerable children will still remain, including those with HIV and those with disabilities. These are at increased risk of death even following successful nutritional treatment compared to malnourished children with no underlying clinical problems (4).