Background: - Malnutrition is one of the leading causes of morbidity and mortality in childrenrnunder the age of five years in developing countries, including in Ethiopia. The most importantrnforms of malnutrition in Ethiopia is protein energy malnutrition, but there is no reliable laboratoryrnmethod present to assess acute malnutrition. Transthyretin level of immunochromatographyrnmethod is one of the newly introduced method for the identification of children with acuternmalnutrition recently admitted to Hospital and used as valuable laboratory measurements in thernidentification of patients requiring malnutrition assessment and nutritional support.rnObjective: - To evaluate acute malnutrition status in children of age less than five years, whornattend in Tikur Anbessa Specialized Hospital and Yekatit 12 hospital; by using anthropometricrnmethods, and by measuring albumin and transthyretin level in blood serum samples.rnMethods: - Hospital based cross sectional study design was applied from August 2014 tornDecember 2014. 51 malnourished and 51 non- malnourished children were recruited for thisrnstudy. Anthropometric measurements (weight, height, length, MUAC) were performed and serumrntransthyretin and albumin levels were measured as biochemical parameters in these hospitalizedrnpatients.rnResults: - The mean age of the cases and controls were 1.14 year and 1.48 year, respectively.rnComparison of mean between control and study group shows 14.32 cm and 10.45 cm for MUAC,rn4.24 g/dl and 3.86 g/dl for albumin and 303.08mg/l and 132.89 mg/l for transthyretin for controlrngroup and study group respectively. All above mean values shows significant difference betweenrncontrols and study groups with p value < 0.0005. Prevalence of malnutrition assessed by weightrnfor height were categorized as 21.6% for moderate malnutrition and 78.4% for severernmalnutrition. Using MUAC it could be predicted that 23.5% were moderately malnourished andrn76.5% were severely malnourished. But using transthyretin tests, the prevalence of 82.4% forrnmoderate malnutrition and 13.7% for severe malnutrition were obtained. Multivariate analysisrnrevealed positive correlation between albumin and transthyretin level (r = 0.307, P=0 .03), butrnthere was no significant correlation between anthropometrics measurement with biochemicalrnmeasurements. The sensitivity and specificity of transthyretin using MUAC as reference standardrnwere 91.60 %, and 15.38% (0.0318 Kappa agreement). The sensitivity of transthyretin usingrnweight for height (wasting) as reference standard was 100 %, and specificity was 17.5 %. (0.16rnKappa agreement). Transthyretin validation by using MUAC as reference material was found tornbe a sensitivity of 81.82 % and specificity of 47.5 % with cut off of transthyretin 120 mg/l.rnConclusions: - Transthyretin is a better acute malnutrition marker in the serial nutritionalrnassessment and it is a cost effective, feasible, reliable tool for malnutrition screening, particularlyrnfor the purpose of settings where it is difficult to perform a more detailed and comprehensivernnutritional assessment.rnKey words: - Transthyretin, Albumin, Anthropometric parameters, Acute Malnutrition