Context: Severe acute malnutrition (SAM) is a major cause of morbidity and mortality in children under 5 years of age, especially in developing countries. Co-morbid conditions such as infections, micronutrient deficiencies and parasitic infestation are mainly responsible for this high mortality in SAM. Aims: To describe anemia and vitamin deficiency in children admitted with SAM at two tertiary level hospitals. Settings and Design: Observational cross sectional study, conducted at two centers. One centre is the Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, and Varanasi and another is Department of Pediatrics, Shyam Shah Medical College Rewa MP. Methods and Material: Children between 6-60 months fulfilling the WHO criteria of SAM were enrolled. Cases were divided into edematous and non edematous groups. We collected data on demography, anthropometry, history and clinical examination including sign of vitamin deficiency. Investigations included CBC, general blood picture, serum electrolytes and calcium, serum albumin, blood sugar. Children were managed as per WHO SAM protocol. Statistical analysis used: The SPSS version 18 was used for data analysis. A p value <0.05 was considered significant. Results: Hundred four patients from MP group and 109 patients from UP group were finally enrolled in the study in which 98 (94.2%) patient out of 104 from MP and 77 (60%) patients out of 109 from UP less than 36 months. In this study male are more affected than female in UP group, male to female ratio is 1.79:1 as (64.2% verse 35.7%). In MP group SAM is more prevalent in lower middle class 51% as compared to upper lower class 31.7%. However in UP groups under nutrition is more common in upper lower 34.8% than lower middle 28.4%. We found out that, Vitamin B deficiency was most common (45.87%) followed by Vitamin A (16.5%) and most common deficiency sign were cheliosis, angular stomatitis and conjunctival xerosis in UP group while in MP group also most common Vitamin B deficiency (18.2%) followed Vitamin A deficiency (8.6%). Conclusions: Anemia and dermatitis are significantly coexist with edematous SAM children at both centers and vitamin deficiencies was frequently seen in edematous SAM children in UP.