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Childhood malnutrition is an important indicator of the health of a population.1 A worldwide analysis recently identified childhood malnutrition as the leading risk factor for the global burden of disease.1 Severe acute malnutrition (SAM) is one of the leading causes of morbidity and mortality in children in developing countries.1,2 Nutritional disorders are frequent in hospitalized patients, of which malnutrition is the most prevalent.2 In developed countries, the frequency of malnutrition among pediatric patients is around 24%.3 Surveys conducted over the past two decades report 15% to 65% malnutrition rates in pediatric patients admitted to the intensive care unit (ICU), with malnourished children presenting a higher incidence of both infection and mortality.4 Recent data have revealed that malnutrition in critically ill hospitalized children ranges from 10% to 24%. However, no independent association with mortality has been found.5 In 2013 prevalence of severe acute malnutrition in Indonesia was 5,7%.6 This condition that kills children and intellectually maims those who survive. The complications caused by malnutrition very diverse. These changes include lowered immune response, atrophy, and increased permeability of the intestinal epithelial barrier, which facilitates infection and bacterial translocation.7 Malnourished patients also suffer from more inadequate healing of wounds, higher incidence of pneumonia, sepsis, and other conditions that can lead to increased mortality, length of hospital stay, and health care costs.7-9 Malnutrition is responsible directly or indirectly for about 50% of deaths among children under five. Factors associated with mortality in children with severe acute malnutrition are blood glucose level, severe anemia, comorbidity, kwashiorkor as a type of SAM and dehydration.10,11 Anemia prevalence in children is high, especially in developing countries, and frequently is multifactorial.12 It is often associated with childhood malnutrition, producing interlinked factors, several of which could be causally related to mortality risk. These factors include lack of hematinic (e.g., iron, folate, vitamins A, B-12 and C, and copper), impairment of red cell production by acute or sub-acute inflammation (with an increase in stored iron) and increased red cell destruction either via specific infections (e.g., malaria) or particular nutrients (e.g., vitamin A). Research in India found a high incidence of severe anemia in SAM with a large proportion (25%) of its requiring blood transfusion.12 The study in Nigeria also revealed high mortality rates among malnutrition children who with severe anemia.13 ABSTRACT

Anemia and metabolic acidosis are a predictor for mortality in children with severe acute malnutrition at Sanglah General Hospital, Bali