What Is SAM?

SAM affects an estimated 13 million children worldwide. Cases are rising, and not just in countries in crisis; children living in relatively stable environments are also increasingly at risk.

Here are some answers to some Frequently Asked Questions:

What is SAM?

Severe acute malnutrition (SAM) is the most deadly form of wasting or malnutrition. It is defined as a low weight-for-height ratio.

How is SAM diagnosed?

Measuring a child’s mid-upper arm circumference. Many children with SAM also suffer from nutritional edema, which presents as swelling in the face, feet and limbs.

How prevalent is it?

SAM is one of the top threats to child survival worldwide, affecting at least 13 million children under age 5, according to UNICEF and partner estimates. Since 2016, countries across multiple regions have seen a rise in levels of SAM, with no clear single reason to explain why.

Conflict, epidemics, climate shocks (flooding, drought) and food insecurity all contribute to the problem. Yet about three-quarters of all children with SAM live in places that are not facing any emergencies or crises.

What causes a child to become acutely malnourished?

Chief causes of severe acute malnutrition include lack of nutritious food and illnesses like diarrhea, measles or malaria.

Underlying drivers are complex and vary widely across contexts. SAM can also result from unsanitary environments and lack of education. Children living in poverty, with limited access to health care and safe drinking water, are also at higher risk.

How does SAM affect children?

Children with SAM appear very thin. Their immune systems are compromised, leaving them vulnerable to disease and developmental delays.

A child suffering from SAM is up to 11 times more likely than a healthy child to die of seemingly mild infections and illnesses like a cold or pneumonia. They have virtually no protection against bacteria, viruses or fungi. Their digestive systems can no longer absorb nutrients. Their bodies are so worn down that it takes all of their energy just to keep breathing.

Is the condition fatal?

If left untreated, yes. SAM is to blame for 1 in 5 deaths of children under age 5 globally, making it a leading cause of child mortality. Malnourished children are more susceptible to disease, and have a harder time fighting infections. Malnourished children die from illnesses that an otherwise healthy child would recover from.

Although the number of children being treated for SAM has risen in recent years, only 1 in 3 are reached with the timely treatment and care they need to survive and thrive. In many areas of the world, prevention and treatment of SAM are under-prioritized and under-resourced, particularly for the most vulnerable and disadvantaged families and communities.

The vast majority of children with SAM who receive treatment (90 percent) are caught in a crisis or emergency that is generating news coverage. 

What does UNICEF do to combat SAM?

Supporting child nutrition — and reaching acutely malnourished children with urgently-needed treatment, care and support — is a top priority for UNICEF emergency teams responding to conflicts, climate disasters and other crises. Learn more about what a UNICEF Emergency Response looks like.

UNICEF also works in regions worldwide to support governments in scaling up prevention and early detection, in addition to treatment services. Some of this work includes supporting the creation and implementation of global guidelines and government policies around interventions.

UNICEF also helps governments integrate SAM care into their primary health care plans and budgets; improve the training and capacity of community health workers to identify and support children with SAM; and improve the quality and accessibility of ready-to-use therapeutic food, which helps affected children recover from SAM in their own homes and communities rather than in a health facility.

Related: Malnourished Children: How UNICEF Fights Child Hunger

What is the Child Nutrition Fund (CNF)?

UNICEF, in collaboration with the Gates Foundation, the Children’s Investment Fund Foundation, the UK government and other private and public partners, established the Child Nutrition Fund (CNF) in 2023 with a goal of raising $2 billion by 2030 to accelerate malnutrition prevention and treatment by scaling up sustainable policies, programs and supplies.

The CNF acts as a financing mechanism led by UNICEF to help global partners coordinate their support to countries and incentivize domestic investments in maternal and child nutrition. 

Malnutrition and undernutrition are prevented when nutritious diets, essential nutrition services and positive nutrition and care practices are available to the most at-risk women and children. Without increased and sustained action, SAM will continue to affect millions of children. Learn more about the UNICEF-led Child Nutrition Fund.

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