e-Library of Evidence for Nutrition Actions (eLENA)


An online library of evidence-informed guidelines for nutrition interventions and single point of reference for the latest nutrition guidelines, recommendations and related information.

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Management of severe acute malnutrition in individuals with active tuberculosis

Intervention | Last updated: 9 August 2023

In 2012 there were an estimated 8.6 million new cases of tuberculosis (TB) globally. TB morbidity and mortality are highest in developing countries.

Undernutrition increases the risk of tuberculosis and vice-versa and, as a result, undernutrition is highly prevalent among people with tuberculosis. Young children and pregnant women are particularly vulnerable to the effects of undernutrition and TB. Women with TB may be at higher risk for pre-eclampsia and other complications during pregnancy. TB also increases the risk of premature birth, low birth weight and perinatal death.

Severe acute malnutrition is identified differently in different age groups:

  • Children under 5 years of age: very low weight-for-height/weight-for-length, or clinical signs of bilateral pitting oedema, or very low mid-upper arm circumference (children 6–59 months of age only)
  • School-age children and adolescents 5–19 years of age: very low BMI*-for-age
  • Adults: very low BMI
  • Pregnant women: very low mid-upper arm circumference

Those suffering from severe acute malnutrition are particularly susceptible to the negative health effects of tuberculosis.

WHO Recommendations

School-age children and adolescents (5–19 years of age), and adults, including pregnant and lactating women, with active TB and severe acute malnutrition should be treated in accordance with the WHO recommendations for management of severe acute malnutrition (IAMI manual, Technical note).

Children who are less than 5 years of age with active TB and severe acute malnutrition should be treated in accordance with the WHO recommendations for the management of severe acute malnutrition in children who are less than 5 years of age (updated guideline on management of SAM).

* BMI = body mass index, kg/m2



Evidence

Systematic reviews used to develop the guidelines

The effectiveness of interventions to treat severe acute malnutrition in young children: a systematic review

Picot J, Hartwell D , Harris P, Mendes D, Clegg AJ, and Takeda A. Health Technology Assessment. 2012; Vol.16:No.19(for Guideline: Updates on the management of severe acute malnutrition in infants and children).

Nutritional supplements for people being treated for active tuberculosis

Sinclair D, Abba K, Grobler L, Sudarsanam TD. Cochrane Database of Systematic Reviews. 2011; Issue 11. Art. No.: CD006086.

Related Cochrane reviews

Nutritional supplements for people being treated for active tuberculosis.

Grobler L, Nagpal S, Sudarsanam TD, Sinclair D.Cochrane Database of Systematic Reviews 2016, Issue 6. Art. No.: CD006086.

Summary of this review Alternate Text

Cost-effectiveness Learn More Alternate Text

Cost-effectiveness analyses

The analyses listed below were conducted to assess the overall cost-effectiveness of inpatient and/or outpatient management of SAM, of which the intervention listed on this webpage is a component. The analyses do not assess the cost-effectiveness of this specific intervention alone.

Cost effectiveness of community-based therapeutic care for children with severe acute malnutrition in Zambia: decision tree model

Bachmann MO. Cost Eff Resour Alloc. 2009 Jan; 7:2.

Cost effectiveness of community-based and in-patient therapeutic feeding programs to treat severe acute malnutrition in Ethiopia

Tekeste A, Wondafrash M, Azene G, Deribe K. Cost Eff Resour Alloc. 2012; 10:4.

Cost effectiveness of a community based prevention and treatment of acute malnutrition programme in Mumbai slums, India

Goudet S, Jayaraman A, Chanani S, Osrin D, Devleesschauwer B, Bogin B, et al. PLoS One. 2018; 13(11):e0205688.

Economic Cost of Community-Based Management of Severe Acute Malnutrition in a Rural District in Ghana

Abdul-Latif A-M C, Nonvignon J. Health. 2014; 6: 886-899.

The cost-effectiveness of forty health interventions in Guinea

Jha P, Bangoura O, Ranson K. Health Policy Plan. 1998; 13(3):249-62.

Costs, cost-effectiveness and financial sustainability of community-based management of acute malnutrition in northern Nigeria

Frankel S, Roland M, Makinen M. Washington DC: Results for Development Institute; 2015.

Cost-effectiveness of community-based management of acute malnutrition in Malawi

Wilford R, Golden K, Walker DG. Health Policy Plan. 2012; 27(2):127-37.

Cost-effectiveness of the community-based management of severe acute malnutrition by community health workers in southern Bangladesh

Puett C, Sadler K, Alderman H, Coates J, Fiedler JL, Myatt M. Health Policy Plan. 2013; 28(4):386-99.

Category 1 Intervention

Guidelines have been recently approved by the WHO Guidelines Review Committee

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