{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T09:46:08Z","timestamp":1792057568439,"version":"4.4.0"},"reference-count":37,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":82,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Maternal &amp;amp; Child Nutrition"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Children with severe acute malnutrition have a 10\u2010fold increased risk of death, diminished intellectual development and poor adult work capacity. Community\u2010based outpatient therapeutic programs are among the key interventions designed to manage uncomplicated severe acute malnutrition at the community level in Ethiopia. Despite its implementation, evaluation involving multi\u2010dimensional data sources such as health system level, service provider level and community level perspectives has not been made so far. A mixed\u2010method evaluation was conducted in the central Gondar zone from January to May 2021. The OTP program is implemented by Ethiopian Ministry of Health. A total of 105 women\/caregivers, 39 health posts, 171 health extension workers, and outpatient therapeutic program registration and reporting documents were included in the study. In\u2010depth interview was conducted with seven HEWs and nine mothers\/caregivers. Moreover, five key informants were selected from district officers and nutrition focal persons. Although more than half of the health posts had the required two HEWs, WHO weight\u2010for\u2010height reference cards, referral forms, length measuring boards and essential drugs were limited in most health posts. Close to a third (35.5%) of the HEWs were recording the routine\u2010given medicine while the majority (98.8%) of them measured and recorded the children's Mid\u2010Upper circumference. Sharing of RUTF for non\u2010eligible children was the observed barrier to adherence to the program. The implementation status of the OTP program was poor. Some medicines were stocked out in all health posts. The majority of the mothers\/caregivers didn't appropriately provide RUTF for their children. Improving resource availability, enhancing HEWs' compliance with the OTP protocol, and ensuring consistent counseling and regular home visits for mothers are recommended to improve recovery outcomes among children with malnutrition.<\/jats:p>","DOI":"10.1111\/mcn.70243","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T07:11:55Z","timestamp":1789974715000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Community\u2010Based Outpatient Therapeutic Program Implementation in Central Gondar Zone, Northwest Ethiopia: A Process Evaluation Using Access and Implementation Fidelity Frameworks"],"prefix":"10.1111","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5264-3858","authenticated-orcid":false,"given":"Chalie Tadie","family":"Tsehay","sequence":"first","affiliation":[{"name":"Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, and Specialized Hospital University of Gondar Gondar Northwest Ethiopia Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5596-8401","authenticated-orcid":false,"given":"Ayal","family":"Debie","sequence":"additional","affiliation":[{"name":"Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, and Specialized Hospital University of Gondar Gondar Northwest Ethiopia Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Getnet Mitike","family":"Kassie","sequence":"additional","affiliation":[{"name":"International Institutes for Primary Health Care \u2013 Ethiopia (IPHC\u2010E) Addis Ababa Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8558-1718","authenticated-orcid":false,"given":"Eskedar Getie","family":"Mekonnen","sequence":"additional","affiliation":[{"name":"Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences University of Gondar Gondar Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3121-5808","authenticated-orcid":false,"given":"Wubet Worku","family":"Takele","sequence":"additional","affiliation":[{"name":"Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, and Specialized Hospital University of Gondar Gondar Northwest Ethiopia Ethiopia"},{"name":"Eastern Health Clinical School Monash University Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0945-188X","authenticated-orcid":false,"given":"Ashenafi Tazebew","family":"Amare","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, and Specialized Hospital University of Gondar Gondar Northwest Ethiopia Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5107-7807","authenticated-orcid":false,"given":"Amare Demsie","family":"Ayele","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, and Specialized Hospital University of Gondar Gondar Northwest Ethiopia Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7076-6146","authenticated-orcid":false,"given":"Tsegaye G.","family":"Haile","sequence":"additional","affiliation":[{"name":"Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, and Specialized Hospital University of Gondar Gondar Northwest Ethiopia Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0238231"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.70174"},{"key":"e_1_2_9_4_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2024-090902","article-title":"Incidence and Predictors of Mortality Among Children With Severe Acute Malnutrition Admitted to Therapeutic Feeding Units in Ethiopia: A Systematic Review and Meta\u2010Analysis","volume":"15","author":"Adugna A.","year":"2025","journal-title":"BMJ Open"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtumed.2023.02.002"},{"key":"e_1_2_9_6_1","first-page":"655","article-title":"Therapeutic Nutrition for Children With Severe Acute Malnutrition: Summary of African Experience","volume":"47","author":"Briend A.","year":"2010","journal-title":"Springer"},{"key":"e_1_2_9_7_1","first-page":"715","article-title":"Nutritional Status, Age and Survival: The Muscle Mass Hypothesis","volume":"43","author":"Briend A.","year":"1989","journal-title":"European Journal of Clinical Nutrition"},{"key":"e_1_2_9_8_1","first-page":"36","article-title":"Treatment Outcome of Severe Acute Malnutrition Among Children (6\u201059 Months) in Outpatient Therapeutic Feeding Program in Gursum District, Somali Region, Ethiopia","volume":"8","author":"Budul A. B.","year":"2020","journal-title":"Science (New York, N.Y.)"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-2-40"},{"key":"e_1_2_9_10_1","first-page":"38","article-title":"Decentralisation and Scale Up of Outpatient Management of SAM in Ethiopia (2008\u20102010)","volume":"40","author":"Chamois S.","year":"2011","journal-title":"Field Exchange"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2006.098327"},{"key":"e_1_2_9_12_1","unstructured":"Del R. andM.Joy Madagascar's Pilot Program for Community Management of Acute Malnutrition: Evaluation Highlights. Basic Support for Institutionalizing Child Survival (BASICS) for USAID (2008)."},{"key":"e_1_2_9_13_1","first-page":"7","article-title":"Effectiveness of Integrated Outpatient Care of Severe Acute Malnutrition in Ethiopia","volume":"34","author":"Eklund M.","year":"2008","journal-title":"Field Exchange"},{"key":"e_1_2_9_14_1","doi-asserted-by":"crossref","unstructured":"Gesesew H. K.Berhane E. S.Siraj et al. 2021. The Impact of War on the Health System of the Tigray Region in Ethiopia: An Assessment.6 no.11.","DOI":"10.1136\/bmjgh-2021-007328"},{"key":"e_1_2_9_15_1","unstructured":"Joint T. U. W. W.2021. 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A. Chad: Acute Malnutrition Situation October \u2010 December 2020 and Projections for January \u2010 May 2021 and June \u2010 September 2021. (2021)."},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1368980014002444"},{"key":"e_1_2_9_28_1","unstructured":"Ministry of Health.2019.National Guideline for the Management of Acute Malnutrition in Ethiopia. Federal Ministry of Health."},{"key":"e_1_2_9_29_1","volume-title":"Evaluation: A Systematic Approach","author":"Rossi P. 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