Severe acute malnutrition (SAM) is a major global health challenge, particularly in low-resource settings like Pakistan, where it significantly contributes to child mortality and morbidity. This article presents the case of Haleema, a 10-month-old infant admitted to Government Nasir Ullah Khan Babar Memorial Hospital with SAM. She exhibited extreme wasting, edema, and weakness, exacerbated by food insecurity and limited healthcare access. Her treatment followed World Health Organization (WHO) guidelines, involving three key phases: stabilization (managing dehydration, infections, and electrolyte imbalances), rehabilitation (nutritional recovery using ready-to-use therapeutic food), and maintenance (ongoing monitoring and family education). With timely intervention, Haleema’s condition improved significantly, demonstrating the effectiveness of structured treatment. This case highlights the critical need for early detection and comprehensive care in managing SAM. Furthermore, it emphasizes the importance of addressing the root causes of malnutrition—poverty, food insecurity, and healthcare barriers—through prevention, education, and policy initiatives. A multi-faceted approach that integrates medical treatment, community engagement, and improved healthcare infrastructure is essential to effectively combat SAM in Pakistan and other affected regions.

Severe acute malnutrition, Food insecurity, Loss of appetite, Fever, Lethergy, Socioecnomic status.

Malnutrition, particularly SAM, is a grave public health concern, especially in low- and middle-income countries like Pakistan. SAM is defined as a condition where a child’s weight-for-height is significantly below the normal range, accompanied by visible signs of wasting, stunted growth, and often severe immune system compromise. This form of malnutrition is a leading cause of child mortality, responsible for approximately 45% of all child deaths worldwide, with its burden particularly heavy in regions like South Asia and Sub-Saharan Africa. Pakistan, with its high poverty rates, inadequate healthcare systems, and insufficient nutritional practices, faces a disproportionately high prevalence of SAM among its children.[1,2]

The factors contributing to SAM in Pakistan are multifaceted, including poor maternal nutrition, inadequate breastfeeding practices, insufficient complementary feeding, and limited access to healthcare. Many regions in Pakistan, particularly rural areas, experience inadequate infrastructure for healthcare, which hinders early detection and timely intervention for malnourished children. The country’s high rates of poverty further exacerbate the issue, as families struggle to provide nutritious food for their children, thus increasing the risk of malnutrition. Social norms and limited knowledge about proper nutrition also play a significant role in perpetuating SAM.[3,4]

This study seeks to highlight the successful management of SAM through the case of Haleema, a young girl from Peshawar, Pakistan, who was treated at the Government Nasir Ullah Khan Babar Memorial Hospital. Haleema’s story provides a compelling example of how effective medical intervention, along with community-based efforts, can significantly improve the prognosis of children suffering from SAM.

Haleema, a two-year-old girl, was brought to the Government Nasir Ullah Khan Babar Memorial Hospital in Peshawar in a critical state of malnutrition. She weighed only 6 kg, which is significantly lower than the average weight of children her age, and exhibited classic signs of SAM, including extreme thinness, weakness, and lack of energy. Her parents, who had limited financial resources and were living in a rural area, had struggled to access proper nutrition and healthcare for their child. Despite the availability of health services in some urban areas, the rural communities in Peshawar often face challenges in terms of transportation, affordability, and awareness about the severity of SAM.

Upon admission, Haleema was immediately placed under intensive medical care. The medical team, including pediatricians, nurses, and nutritionists, followed a structured protocol for managing SAM, which included stabilizing her nutritional status through therapeutic feeding. She was provided with ready-to-use therapeutic food (RUTF), a high-calorie, nutrient-dense paste designed to treat malnutrition. The hospital staff also worked to manage her underlying infections, as SAM children are highly susceptible to illness due to their weakened immune systems.

In addition to medical intervention, Haleema’s case underscored the importance of proper breastfeeding and complementary feeding practices. Haleema’s mother, like many others in the region, had limited knowledge about proper feeding techniques. She was counseled by the hospital’s nutritionists on the importance of exclusive breastfeeding in the first six months of life, as well as how to introduce age-appropriate complementary foods after that. The hospital also provided Haleema’s family with guidance on ensuring a balanced diet to support her recovery and long-term growth.

Over the course of several weeks, Halima’s condition began to improve significantly. Her weight increased, and she regained her energy and appetite. The medical team continued to monitor her closely and gradually transitioned her to a maintenance diet as her nutritional status stabilized. Her recovery was a testament to the effectiveness of comprehensive care, which included not only medical treatment but also education and support for the family.

Haleema, a young child, was referred to the hospital by a local healthcare provider after presenting with alarming signs of severe malnutrition (SAM). These symptoms included extreme weight loss, high fever, and gastrointestinal distress, all of which indicated a critical condition. Upon admission to the hospital, it was discovered that Haleema weighed only 5 kg, which was significantly lower than the expected weight for her age. This marked a clear deviation from normal growth standards, prompting immediate concern among healthcare professionals. Diagnostic evaluations confirmed the diagnosis of SAM, a condition often characterized by insufficient nutrient intake and inadequate calorie consumption, leading to severe nutrition. SAM is associated with high mortality rates if not treated promptly and appropriately, as it severely weakens the body’s ability to fight infections and sustain basic functions. In the Haleema case, the presence of fever and gastrointestinal distress suggested possible underlying infections exacerbating her condition.

The management of SAM typically involves a combination of therapeutic feeding, infection control, and addressing any underlying causes of malnutrition. Prompt medical intervention is crucial to stabilizing the patient, improving nutritional status, and preventing long-term developmental issues. Haleema underscores the urgent need for timely diagnosis and treatment of severe malnutrition in vulnerable populations, especially children.

The medical team, led by Dr. Hamid Iqbal, initiated an intensive treatment regimen for Haleema. The management approach involved a combination of nutritional therapy, fluid and electrolyte rehydration, antibiotic treatment for possible underlying infections, and regular monitoring of vital signs. The interventions were as follows:

Nutritional Therapy: A targeted therapeutic feeding program was initiated, which included RUTF and oral rehydration salts (ORS).

Rehydration and Electrolyte Management: Aggressive rehydration was undertaken using intravenous fluids to correct dehydration and restore electrolyte balance.

Antibiotic Therapy: Haleema was prescribed antibiotics to manage any underlying infection, which is a common comorbidity in cases of SAM.

Close Monitoring: The patient was closely monitored for improvement, with regular assessments of her weight, height, and nutritional status.

After six weeks of treatment, Haleema showed substantial improvement:

Weight gain: From 5 kg to 7.5 kg (an increase of 2.5 kg).

Resolution of symptoms: Diarrhea, vomiting, and fever significantly decreased.

Weight-for-Height Z-Score (WHZ): Increased from -3.5 to -1.5, indicating a marked improvement in her nutritional status.

Mid-upper arm circumference (MUAC): Increased from 10 cm to 12.5 cm, a key indicator of nutritional recovery.

The key factors that contributed to her recovery included:

Early detection and treatment: Early recognition of SAM and prompt initiation of nutritional therapy and rehydration led to a significant improvement in her condition.

Comprehensive care: A holistic treatment approach, including nutritional support, infection management, and careful monitoring, was essential in restoring Haleema health.

Healthcare system support: The involvement of trained healthcare professionals, including pediatricians and nutritionists, played a vital role in Haleema recovery.

Haleema recovery highlights several key points about the successful management of SAM in resource-limited settings. First, timely medical intervention is critical in the treatment of SAM. Hospitals like the Government Nasir Ullah Khan Babar Memorial Hospital play an essential role in providing specialized care for severely malnourished children. The availability of therapeutic foods and trained health professionals can make a significant difference in the outcomes for SAM children.

Second, community-based education and support are crucial to preventing malnutrition in the first place. Haleema case illustrates the importance of maternal education in improving feeding practices, which is often the root cause of SAM. Awareness campaigns targeting rural populations can increase knowledge about the importance of breastfeeding, complementary feeding, and the need for balanced diets, thereby reducing the incidence of SAM.[5-7]

Lastly, Haleem’s story reflects the importance of an integrated approach to tackling child malnutrition. Collaboration between healthcare providers, local communities, and governmental organizations is necessary to address the underlying causes of malnutrition and ensure long-term solutions.

SAM is defined by a weight-for-height Z-score below -3, MUAC less than 11.5 cm, or the presence of nutritional edema. SAM is often compounded by infections, dehydration, and electrolyte imbalances, which contribute to increased morbidity and mortality in children. The etiology of SAM in Pakistan is multifactorial, with poverty, lack of access to clean water, inadequate nutrition, and limited healthcare facilities being significant contributors. [8-10]

According to the WHO, SAM is responsible for approximately 1 million child deaths annually, and the burden is particularly high in South Asia. Pakistan’s rural and underserved populations are disproportionately affected by malnutrition, with poor maternal nutrition and limited access to early healthcare services exacerbating the problem.[1]

Haleema’s case is an example of how timely intervention can reverse the detrimental effects of SAM.

In conclusion, the successful treatment of Haleema demonstrates the power of timely intervention, medical expertise, and community engagement in combating SAM. Her recovery serves as a beacon of hope, emphasizing that malnutrition is a preventable and treatable condition. However, achieving long-term progress requires addressing the systemic challenges that perpetuate malnutrition in Pakistan. By investing in healthcare infrastructure, empowering communities with knowledge, and tackling the socio-economic determinants of malnutrition, Pakistan can pave the way for a healthier future for its children. Haleema journey is not just a story of recovery; it is a call to action for stakeholders at all levels to prioritize the fight against malnutrition.

We extend our deepest gratitude to the dedicated medical and nursing staff at the Nasir Ullah Khan Babar Memorial Hospital, government, for their unwavering commitment and exceptional care provided to Haleema throughout her treatment journey. Their expertise, compassion, and tireless efforts played a pivotal role in her recovery and in demonstrating the profound impact of quality healthcare in saving lives.

A special thanks goes to Mr. Saffdar Khattak for his invaluable nutritional expertise, which was instrumental in designing and implementing the Haleema therapeutic feeding regimen. His guidance ensured that her nutritional rehabilitation was not only effective but also tailored to her specific needs, enabling her to regain her health and vitality.

We would also like to acknowledge the contributions of Mr. Muhammad Suliman, whose diligent efforts in data collection and documentation significantly enhanced the comprehensiveness of this report. His meticulous work has provided an essential foundation for understanding the broader implications of the Haleema case and for drawing lessons to combat SAM in similar contexts.

Finally, we extend our heartfelt appreciation to the Haleema family for their patience, cooperation, and trust in the medical team throughout the treatment process. Their willingness to learn and adapt to new nutritional and caregiving practices was vital in ensuring Haleema long-term recovery and well-being.

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Corresponding Author:
Bilal Noor
Department of Pediatric Medicine
Doggar Hospital, Pakistan
Email: Bilalzk261@gmail.com

Co-Authors:
Hamid Iqbal
Department of Pediatric Medicine
Naseerullah Babar Hospital Peshawar, Pakistan

Muhammad Suliman
Department of Clinical Technology
Doggar Hospital, Pakistan

Saffdar Khattak
Department of Clinical Nutrition
Nasir Ullah Khan Babar Memorial Hospital Peshawar, Pakistan

All authors contributed to the conceptualization, investigation, and data curation by acquiring and critically reviewing the selected articles. They were collectively involved in the writing – original draft preparation, and writing – review & editing to refine the manuscript. Additionally, all authors participated in the supervision of the work, ensuring accuracy and completeness. The final manuscript was approved by all named authors for submission to the journal.

The author declares no conflict of interest.

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https://doi.org/10.63096/medtigo30623118

Bilal N, Hamid I, Muhammad S, Saffdar K. A Case Study on Severe Acute Malnutrition: Halema Journey to Health at Government Nasir Ullah Khan Babar Memorial Hospital, Peshawar, Pakistan. medtigo J Med. 2025;3(1):e30623118.
doi:10. 63096/medtigo30623118 Crossref