Introduction:Severe acute malnutrition (SAM) is a significant public health issue among children under five, contributing to high morbidity and mortality rates. This study aims to evaluate the rate of relapse and mortality among children with SAM after discharge from the Nutritional Rehabilitation Centre (NRC) at Ballari Medical College and Research Center(BMCRC),Ballari and to identify predictors of these outcomes. Methodology:This retrospective longitudinal study included children aged 6-60 months admitted with SAM to the NRC at BMCRCBallari between January 2023 and June 2023. The children were followed up for six months post-discharge, with anthropometric measurements and assessments of relapse and mortality recorded at one week, two weeks after the first and second follow-ups, one month after the third follow-up, and six months post-discharge. Multivariable regression analysis was conducted to identify factors associated with SAM relapse. Results:The study included 209 children, with a relapse rate of 22.22% observed over the follow-up period. Younger age (6-11 months) and lower mid-upper arm circumference (MUAC) at discharge were significant predictors of relapse. The nutritional status of the children improved progressively during follow-up, with the proportion of severely malnourished children decreasing from 48.89% at discharge to 21.28% at six months post-discharge. Conclusion:The findings indicate that younger age, female gender, and lower MUAC at discharge are key predictors of SAM relapse, with a relapse rate of 22.22% observed over the follow-up period.One significant factor has been observed that the many patients do not remain in the hospital until they achieve their target weight of <-1 SD. While the discharge criteria are well-defined, patients often leave before reaching their target milestone, which requires a longer duration of stay. This premature discharge, due to patients' unwillingness to remain hospitalized for an extended period, could be a key reason for the observed relapse, and patient who did not come for follow up in them relapse is still unknown, hence exact relapse post discharge still under estimated.