Background: Mortality in children with Severe Acute Malnutrition (SAM) remains high despite the adoption of available standard operative procedures for treatment. Aim: To determine the risk factors for mortality and assess the effectiveness of treatment protocol in severely malnourished children. Materials and Methods: This was a retrospective study based on data extracted from the case files of children aged six months to 5-years who were admitted and managed for Severe Acute Malnutrition in the Emergency Paediatrics Unit (EPU) and Paediatrics Medical Ward (PMW) of the Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, Nigeria, over five years (from January 1 2015 to December 31 2019). Data were analyzed using the IBM SPSS version 25 computer statistical software package. Results: Whereas the presence of pneumonia, coma, gastrointestinal loses > 5 times/day, small pulse volume, use of Rehydration Solution for the Malnourished (ReSoMal), and hypoglycaemia were associated with mortality in SAM (p < 0.05), in logistic regression analysis, none of them was a significant risk factor for mortality. ReSoMal was effective in correcting dehydration among the discharge group but ineffective among the mortality group due to severe dehydration and intolerance. Conclusions: ReSoMal was effective for correcting dehydration in children who could tolerate it orally and were not severely dehydrated. Healthcare providers should triage children with SAM into those who can tolerate the oral route for ReSoMal administration, while those who cannot and those who are severely dehydrated should be considered for initial resuscitation with intravenous fluid to optimize survival.