title: Severe malnutrition in children presenting to health facilities in an urban slum in Bangladesh.
abstract: METHODS
  An urban slum in Kamrangirchar, Bangladesh.
  
  
  OBJECTIVE
  Among children aged 6-59 months seeking medical care from the two Médecins Sans Frontières-supported primary health centres, to determine 1) the prevalence of severe acute malnutrition (SAM) and severe chronic malnutrition (SCM), and 2) the extent of overlap between SAM and SCM.
  
  
  METHODS
  In a retrospective record review, data were analysed from out-patient registers on age, sex, height, weight and mid-upper arm circumference (MUAC) of children attending for medical care from April to September 2011. SAM was defined as weight for height < -3 Z scores of the median and/or MUAC <115 mm. SCM was defined as height for age < -3 Z scores of the median. World Health Organization growth standards were used as reference.
  
  
  RESULTS
  Data were complete in the records of 7318 (98%) children, of whom 322 (4%) had SAM and 1698 (23%) had SCM. Among the 322 children with SAM, 162 (50%) also had SCM.
  
  
  CONCLUSIONS
  In an urban Bangladesh slum, SAM and SCM co-exist, with a predominance of SCM. The current national guidelines for severe malnutrition, which focus on identification and management only for SAM, urgently need to be expanded to include SCM if substantial childhood morbidity and mortality are to be reduced.
authors.affiliation: Médecins Sans Frontières (MSF), Kamrangirchar, Dhaka, Bangladesh.
authors.forename: Z
authors.initials: Z
authors.lastname: Shams
authors.affiliation: MSF-Operational Centre Brussels, Medical Department, Operational Research Unit, Luxembourg, Luxembourg.
authors.forename: R
authors.initials: R
authors.lastname: Zachariah
authors.affiliation: International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.
authors.forename: D A
authors.initials: DA
authors.lastname: Enarson
authors.affiliation: The Union, South-East Asia Regional Office, New Delhi, India.
authors.forename: S
authors.initials: S
authors.lastname: Satyanarayana
authors.affiliation: MSF-Operational Centre Brussels, Medical Department, Operational Research Unit, Luxembourg, Luxembourg.
authors.forename: R
authors.initials: R
authors.lastname: Van den Bergh
authors.affiliation: MSF-Operational Centre Brussels, Medical Department, Operational Research Unit, Luxembourg, Luxembourg.
authors.forename: E
authors.initials: E
authors.lastname: Ali
authors.affiliation: MSF-Operational Centre Brussels, Medical Department, Operational Research Unit, Luxembourg, Luxembourg.
authors.forename: P
authors.initials: P
authors.lastname: Alders
authors.affiliation: MSF-Operational Centre Brussels, Medical Department, Operational Research Unit, Luxembourg, Luxembourg.
authors.forename: M
authors.initials: M
authors.lastname: Manzi
authors.affiliation: MSF-Operational Centre Brussels, Medical Department, Operational Research Unit, Luxembourg, Luxembourg.
authors.forename: M
authors.initials: M
authors.lastname: Allaouna
authors.affiliation: MSF-Operational Centre Brussels, Medical Department, Operational Research Unit, Luxembourg, Luxembourg.
authors.forename: B
authors.initials: B
authors.lastname: Draguez
authors.affiliation: MSF-Operational Centre Brussels, Medical Department, Operational Research Unit, Luxembourg, Luxembourg.
authors.forename: P
authors.initials: P
authors.lastname: Delchevalerie
authors.affiliation: Médecins Sans Frontières (MSF), Kamrangirchar, Dhaka, Bangladesh.
authors.forename: L
authors.initials: L
authors.lastname: Vernaeve
authors.affiliation: International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
keywords: Bangladesh; children; operational research; severe acute malnutrition; severe chronic malnutrition; urban slum