Dear Ahmed, We had some previous discussion on this issue on en-net, which can be found here: [url]http://www.en-net.org.uk/question/171.aspx[/url] However, since this was back in 2009, I am posting your question to see if there are any recent developments on this. Best wishes, Tamsin

This issue is discussed in the 2013 WHO update on SAM management available at : [url]http://www.who.int/nutrition/publications/guidelines/updates_management_SAM_infantandchildren/en/[/url] UPDATES ON THE MANAGEMENT OF SEVERE ACUTE MALNUTRITION IN INFANTS AND CHILDREN The recommendations are as follows: Children with severe acute malnutrition should receive the daily recommended nutrient intake of vitamin A throughout the treatment period. Children with severe acute malnutrition should be provided with about 5000 IU vitamin A daily, either as an integral part of therapeutic foods or as part of a multi-micronutrient formulation. strong recommendation, low quality evidence Children with severe acute malnutrition do not require a high dose of vitamin A as a supplement if they are receiving F-75, F-1001 or ready-to-use therapeutic food that comply with WHO specifications (and therefore already contain sufficient vitamin A), or vitamin A is part of other daily supplements. strong recommendation, low quality evidence Children with severe acute malnutrition should be given a high dose of vitamin A (50 000 IU, 100 000 IU or 200 000 IU, depending on age) on admission, only if they are given therapeutic foods that are not fortified as recommended in WHO specifications and vitamin A is not part of other daily supplements. strong recommendation, low quality evidence See the WHO documents for more details.