{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T10:47:04Z","timestamp":1788173224042,"version":"build-2803163510"},"reference-count":68,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,10,21]],"date-time":"2024-10-21T00:00:00Z","timestamp":1729468800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Maternal &amp; Child Nutrition"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>An integrated care pathway to manage small and nutritionally at\u2010risk infants under 6 months (u6m) and their mothers (MAMI Care Pathway) is consistent with 2023 WHO malnutrition guidelines and is being tested in a randomised controlled trial (RCT) in Ethiopia. To optimise trial implementation, we investigated contextual fit with key local stakeholders. We used scenario\u2010based interviews with 17 health workers and four district managers to explore perceived feasibility. Eighteen policymakers were also surveyed to explore policy coherence, demand, acceptability, evidence needs, opportunities and risks. The Bowen feasibility framework and an access to health care framework were adapted and applied. Health workers perceived the MAMI Care Pathway as feasible to implement with support to access services and provide care. The approach is acceptable, given consistency with national policies, local protocols and potential to improve routine care quality. Demand for more comprehensive, preventive and person\u2010centred outpatient care was driven by concerns about unmet, hidden and costly care burden for health services and families. Inpatient care only for severe wasting treatment is inaccessible and unacceptable. Support for routine and expanded components, especially maternal mental health, is needed for successful implementation. Wider contextual factors may affect implementation fidelity and strength. Policymakers cautiously welcomed the approach, which resonates with national commitments, policies and plans but need evidence on how it can work within varied, complex contexts without further system overstretch. A responsive, pragmatic randomised controlled trial will generate the most useful evidence for policymakers. Findings have informed trial preparation and implementation, including a realist evaluation to contextualise outcomes.<\/jats:p>","DOI":"10.1111\/mcn.13749","type":"journal-article","created":{"date-parts":[[2024,10,21]],"date-time":"2024-10-21T12:09:00Z","timestamp":1729512540000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Strengthening implementation of integrated care for small and nutritionally at\u2010risk infants under six months and their mothers: Pre\u2010trial feasibility study"],"prefix":"10.1111","volume":"21","author":[{"given":"Marie","family":"McGrath","sequence":"first","affiliation":[{"name":"Emergency Nutrition Network Oxford UK"},{"name":"Department of Population Health, Faculty of Epidemiology and Population Health London School of Hygiene and Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shimelis","family":"Girma","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health Jimma University Jimma Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melkamu","family":"Berhane","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health Jimma University Jimma Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mubarek","family":"Abera","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health Jimma University Jimma Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4178-6016","authenticated-orcid":false,"given":"Endashaw","family":"Hailu","sequence":"additional","affiliation":[{"name":"GOAL Ethiopia EW Harargehe Program Area Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hatty","family":"Bathorp","sequence":"additional","affiliation":[{"name":"GOAL Global Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Grijalva\u2010Eternod","sequence":"additional","affiliation":[{"name":"Department of Population Health, Faculty of Epidemiology and Population Health London School of Hygiene and Tropical Medicine London UK"},{"name":"Institute for Global Health University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirkuzie","family":"Woldie","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management Jimma University Jimma Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alemseged","family":"Abdissa","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health Jimma University Jimma Ethiopia"},{"name":"Armauer Hansen Research Institute Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsinuel","family":"Girma","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health Jimma University Jimma Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3745-7317","authenticated-orcid":false,"given":"Marko","family":"Kerac","sequence":"additional","affiliation":[{"name":"Department of Population Health, Faculty of Epidemiology and Population Health London School of Hygiene and Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracey","family":"Smythe","sequence":"additional","affiliation":[{"name":"Department of Population Health, International Centre for Evidence in Disability, Faculty of Epidemiology and Population Health London School of Hygiene and Tropical Medicine London UK"},{"name":"Division of Physiotherapy, Department of Health and Rehabilitation Sciences Stellenbosch University Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,10,21]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.foodpol.2022.102367"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2021-005802"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czaa009"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/16549716.2022.2147289"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001812"},{"key":"e_1_2_10_7_1","doi-asserted-by":"crossref","unstructured":"Bayou N. B. Tesfaye B. Gelaye K. Worku A. Haneuse S. Tadesse L. Bekele D. Eticha G. Chan G. &Girma T.(2023).Quality of care provided to sick children in health facilities in Ethiopia: A systematic review.https:\/\/doi.org\/10.21203\/rs.3.rs-3445980\/v1","DOI":"10.21203\/rs.3.rs-3445980\/v1"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2009.02.002"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2016.02.009"},{"key":"e_1_2_10_10_1","volume-title":"Scaling up\u2013from vision to large\u2010scale change from vision to Large\u2010scale change: A management framework for practitioners","author":"Cooley","year":"2020"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-023-09131-1"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-069698"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcop.22531"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0150205"},{"key":"e_1_2_10_15_1","unstructured":"ENN UCL & ACF. (2010). MAMI Project. Technical review: Current evidence policies practices & programme outcomes."},{"key":"e_1_2_10_16_1","volume-title":"Ethiopia Mini Demographic and Health Survey 2019: Final Report","author":"Ethiopian Public Health Institute (EPHI) [Ethiopia] & ICF","year":"2021"},{"key":"e_1_2_10_17_1","unstructured":"Federal Democratic Republic of Ethiopia. (2021).National Food and Nutrition Strategy."},{"key":"e_1_2_10_18_1","volume-title":"National Guideline for the Management of Acute Malnutrition","author":"Federal Ministry of Health Ethiopia","year":"2019"},{"key":"e_1_2_10_19_1","unstructured":"Global Nutrition Report Stakeholder. (2020). 2020 Global Nutrition Report: Action on equity to end malnutrition (978\u20101\u20109164452\u20107\u20107).https:\/\/globalnutritionreport.org\/reports\/20%0A-global-nutrition-report\/executive-summary\/%0A"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-018-1089-4"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2020-003161"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.26596\/wn.202314158-75"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.12345"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12954-023-00858-y"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czw001"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.3389\/frhs.2023.1162762"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-5-67"},{"key":"e_1_2_10_28_1","volume-title":"Qualitative data analysis with NVivo","author":"Jackson K.","year":"2019"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0271733"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2010.191882"},{"key":"e_1_2_10_31_1","doi-asserted-by":"crossref","unstructured":"Kerac M. James P. T. McGrath M. G. Brennan E. Opondo C. &Frison S.(2021).Infant malnutrition in low\u2010 and middle\u2010income countries: Assessment and prevalence of small and nutritionally at\u2010risk infants aged under 6 months in 54 Demographic Health Survey datasets.medRxiv.https:\/\/doi.org\/10.1101\/2021.12.23.21268306","DOI":"10.1101\/2021.12.23.21268306"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.12688\/gatesopenres.12884.1"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(23)00522-6"},{"key":"e_1_2_10_34_1","unstructured":"Lelijveld N. McGrath M. Mertens A. Mwangome M. Talbert A. Rana R. Brennan E. &M. K.(2020).Growth failure in infants younger than 6 months: A scoping review."},{"issue":"43","key":"e_1_2_10_35_1","first-page":"15","article-title":"CMAM rollout in Ethiopia: The \u2018way in\u2019 to scale up nutrition","volume":"43","author":"Lemma F.","year":"2012","journal-title":"Field Exchange"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1186\/1475-9276-12-18"},{"key":"e_1_2_10_37_1","volume-title":"MAMI Care Pathway Package. v3","author":"MAMI Global Network, ENN, & LSHTM","year":"2021"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.o3025"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-018-0758-1"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-069359"},{"key":"e_1_2_10_41_1","volume-title":"Invisible pursuit: Global policy guidance on care of vulnerable infants under 6 months and their mothers, a scoping review","author":"McGrath M.","year":"2024"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-023-06480-z"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.1093\/cdn\/nzab146"},{"key":"e_1_2_10_44_1","unstructured":"Ministry of Health Ethiopia. (2021). Health Sector Transformation Plan II. HSTP II 2020\/21\u20102024\/25 (2013 EFY\u20132017 EFY)."},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.1177\/1356389018803219"},{"key":"e_1_2_10_46_1","doi-asserted-by":"publisher","DOI":"10.1097\/acm.0000000000000388"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2013-002889"},{"key":"e_1_2_10_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)01198-4"},{"key":"e_1_2_10_49_1","doi-asserted-by":"publisher","DOI":"10.1177\/16094069221093137"},{"key":"e_1_2_10_50_1","unstructured":"Partnership Brokers Association. (2019). Brokering Better Partnerships. By investing in the partnering process."},{"key":"e_1_2_10_51_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40814-020-00634-w"},{"key":"e_1_2_10_52_1","doi-asserted-by":"publisher","DOI":"10.3389\/frhs.2022.942658"},{"key":"e_1_2_10_53_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12961-022-00848-9"},{"key":"e_1_2_10_54_1","doi-asserted-by":"publisher","DOI":"10.2139\/ssrn.4531255"},{"key":"e_1_2_10_55_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-018-1076-9"},{"key":"e_1_2_10_56_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n2061"},{"key":"e_1_2_10_57_1","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"e_1_2_10_58_1","unstructured":"UNICEF. (2021). No time to waste: Improving diets services and practices for the prevention early detection and treatment of wasting in early childhood.New York."},{"key":"e_1_2_10_59_1","unstructured":"UNICEF. (2022). UNICEF Strategic Plan: 2022\u20132025. Renewed ambition towards 2030."},{"key":"e_1_2_10_60_1","unstructured":"UNICEF FAO UNHCR WFP & WHO. (2021). Global Action Plan on Child Wasting: A framework for action to accelerate progress in preventing and managing child wasting and the achievement of the Sustainable Development Goals New York."},{"key":"e_1_2_10_61_1","unstructured":"United Nations. (2015).Transforming our world: the 2030 agenda for sustainable development.A\/RES\/70\/1.www.sustainabledevelopment.un.org"},{"key":"e_1_2_10_62_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61692-4"},{"key":"e_1_2_10_63_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00394-9"},{"key":"e_1_2_10_64_1","unstructured":"WHO. (2013).WHO Guidelines Approved by the Guidelines Review Committee. InGuideline: Updates on the Management of Severe Acute Malnutrition in Infants and Children. World Health Organization."},{"key":"e_1_2_10_65_1","unstructured":"WHO & ExpandNet. (2011).Beginning with the end in mind. Planning pilot projects and other programmatic research for successful scaling up."},{"key":"e_1_2_10_66_1","unstructured":"World Health Organisation. (2014).Integrated Management of Childhood Illness: distance learning course. Chart booklet."},{"key":"e_1_2_10_67_1","unstructured":"World Health Organisation. (2023).WHO guideline on the prevention and management of wasting and nutritional oedema (acute malnutrition) in infants and children under 5 years.World Health Organisation."},{"key":"e_1_2_10_68_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czz068"},{"key":"e_1_2_10_69_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-023-10253-9"}],"container-title":["Maternal &amp; Child Nutrition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/mcn.13749","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,17]],"date-time":"2024-12-17T10:01:09Z","timestamp":1734429669000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/mcn.13749"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,21]]},"references-count":68,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1111\/mcn.13749"],"URL":"https:\/\/doi.org\/10.1111\/mcn.13749","archive":["Portico"],"relation":{},"ISSN":["1740-8695","1740-8709"],"issn-type":[{"value":"1740-8695","type":"print"},{"value":"1740-8709","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,21]]},"assertion":[{"value":"2024-03-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-10-01","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-10-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e13749"}}