Acute malnutrition remains one of the leading causes of under-five morbidity and mortality in India. The Community-based Management of Acute Malnutrition (CMAM) approach seeks to institutionalize a continuum of care for addressing severe acute malnutrition (SAM) and moderate acute malnutrition (MAM). It achieves this by leveraging a combined protocol for acute malnutrition through both community- and facility-based approaches within the healthcare system. This model unifies the treatment protocol for children with uncomplicated SAM and MAM in line with the recent CMAM/AMMA protocol released by the Government of India (GOI), adopting simplified diagnostic criteria based on growth monitoring (height and weight) and energy-dense nutrient food (EDNF) supplementation.

Although the approach has been widely adopted, district-level evidence on what happens after a child enters treatment—including recovery rates, time to recovery, relapse, non-response, and mortality—remains limited. This gap constrains efforts to optimize CMAM delivery. This longitudinal cohort study is designed to identify and enroll children with SAM and MAM in close coordination with Anganwadi Centres (AWCs), ensure they receive designed nutrition intervention services, and monitor and follow up with study participants to assess the impact of the CMAM program.

By systematically documenting the treatment outcomes and determinants of SAM and MAM management within routine CMAM programs, this study will help close that evidence gap. It is being conducted across two states—Andhra Pradesh and Rajasthan—with technical leadership from the National Centre of Excellence for the Management of Severe Acute Malnutrition (NCoESAM) at Kalawati Saran Children’s Hospital, New Delhi.

The Andhra Pradesh (AP) arm of the study is implemented in Parvatipuram Manyam district. Parvathipuram Manyam is a recently formed (since April 2022) administrative district, carved out from parts of the Vizianagaram and Srikakulam districts, and located in the northern coastal plains of Andhra Pradesh. According to the 2011 census, the district had a population of 9.25 lakhs, with Scheduled Castes and Scheduled Tribes accounting for 11.91% and 28.14% of the population, respectively.

This study is implemented through the existing Integrated Child Development Services (ICDS)/Anganwadi platform. Case identification is reconciled against the Poshan Tracker (PT), and screening and follow-up outputs feed into program monitoring.

The primary objectives of the study are to:

1. Estimate separately the proportion of SAM and MAM children whose recovery is attributable to the CMAM program. And
2. Determine the median time to recovery.

The secondary objectives include:

1. Assess non-response and mortality rates among enrolled SAM and MAM children.
2. Estimate relapse rates at 8 and 12 weeks post-discharge.
3. Identify demographic, clinical, household, and program-level determinants of recovery.

Field staff were recruited and trained between February and March 2026. Children with SAM/MAM are enrolled following defined inclusion-exclusion criteria. The first set of study participants was enrolled during April and May 2026, and the second set was enrolled during June and July 2026. Research team members are paying regular visits to the respective AWCs to ensure that enrolled children receive all necessary services. Growth monitoring and follow-up of recruited study participants have been ongoing since May 2026 and will continue until November 2026. An appropriate management information system (MIS) is maintained, and data is analyzed fortnightly to monitor the progress of enrolled children. The nutritional status of the enrolled children at the end of the study period will be analyzed and reported.