Table 8 Reasons for negative outcomes and proposed possible suggestions

• Distance between home and treatment centres

• Providing CMAM services directly in a greater number of communities using community based health workers (CHWs) or health extension workers (HEWs) to deliver CMAM services in their own communities.

• Lower MUAC at admission

• Late treatment seeking (i.e. lower MUAC at admission) is usually associated with high opportunity costs [31]. These can be reduced by reducing time-to-travel / distance.

• Allowing mothers / caretakers to screen their own children to identify malnutrition early, facilitating referral and admission into malnutrition treatment program is recommended so as to reduce cost and decrease the rate of hospitalization [31, 32].

• Having diarrhoea, vomiting, fever and cough during the treatment episode that reduced response to treatment.

• Counseling of mothers by clinic staff and community-based volunteers regarding the importance of early treatment seeking for conditions such as diarrhoea, vomiting, fever, and cough at any time and especially during the treatment episode.

• Counseling mothers on appropriate treatment (i.e. ORS) for conditions such as diarrhoea and vomiting.

• Delivery and adherence to the full CMAM protocol to all cases while under treatment in program sites

• Enhanced clinical screening of all beneficiaries at each visit to facilitate early detection of comorbidities. A two-stage screen employing a simple formal question-set administered by lower-level clinic staff followed by a clinical screen by a nurse or doctor is likely to prove the most cost-effective approach.

• Provision of effective (i.e. second or third line) antimicrobials to all children with infections needing treatment