Peer-reviewed article
Outpatient and community-based management of malnourished infants aged under six months (infants u6m at risk of poor growth and development): a scoping review.
Mohammad Hamid Al Muktadir, Nieves Amat Camacho, Rafael Castro-Delgado ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This scoping review examined evidence on outpatient and community-based care for malnourished infants under six months. The review found 26 studies, mostly from sub-Saharan Africa and South Asia, showing that outpatient care is feasible with recovery rates between 65% and 91%. Key interventions included breastfeeding support, maternal health services, and use of tools like MAMI clinical pathways and MUAC measurements. Major barriers to scaling these approaches include staff shortages, inconsistent protocols, and reluctance to adopt outpatient models in national policies.
Key points
- Recovery rates for malnourished infants under six months in outpatient settings ranged from 65% to 91% across multiple contexts
- Breastfeeding support, maternal health, and culturally adapted interventions were identified as important components of care
- Clinical tools such as MAMI care pathway, MUAC, and MAMI WAZ look-up chart were described as effective but need further validation
- Major barriers to implementation include shortages of trained staff, inconsistent protocols, and policy reluctance to scale outpatient models
- Only 5 of 26 included studies were published since the 2023 WHO updated guidelines, suggesting limited recent evidence
Limitations
This is a scoping review that synthesizes diverse studies with methodological heterogeneity, which limits direct comparability of outcomes across contexts. The review cannot establish causality or determine the effectiveness of specific interventions through rigorous comparison, and most evidence comes from only two regions (sub-Saharan Africa and South Asia).
Abstract
Malnourished infants under six months (u6m) are a vulnerable but insufficiently prioritised group, with low levels of consolidated evidence to guide outpatient and community-based care. This study synthesised evidence on outpatient and community-based management of malnourished infants u6m, focusing on intervention strategies, outcomes, barriers, and policy implications. Following the JBI framework and PRISMA guidelines, this review included information published in English between 2007 and 2025 about the outpatient or community-based management of malnourished infants u6m or mother–infant dyads. Four databases and multiple institutional websites were searched, supplemented by grey literature. Data were extracted on various study features, interventions, and outcomes. A total of 26 studies were included, with only five published since the 2023 updated guidelines of the World Health Organization (WHO). Evidence was concentrated in studies from sub-Saharan Africa and South Asia. Several studies described outpatient care as feasible and acceptable in multiple contexts, with reported recovery rates ranging from 65% to 91%; however, methodological heterogeneity limits comparability across studies. Breastfeeding support, maternal health, and culturally adapted interventions were described as important indicators. Tools such as the MAMI clinical care pathway, MUAC, and the MAMI WAZ look-up chart were described as effective, but require further validation and contextual testing. Major barriers that were mentioned included shortages of trained staff, inconsistent protocols, and policy reluctance to scale outpatient models. Outpatient and community-based care for malnourished infants u6m aligns with recent WHO guidance on managing ‘at-risk’ infants. However, widespread adoption requires stronger evidence-based management or tools, integration into health systems, and national policies. Strengthening research and programmatic consensus will be essential to improve outcomes for this vulnerable population.